Actinomyces Europaeus: A Case Report of a Rare Subcutaneous Infection Following Abdominoplasty and a Review of the Literature.

Actinomyces europaeus is an emerging Gram-positive bacterium associated with skin and soft tissue infections. It exhibits intrinsic resistance to multiple antibiotics, and its fastidious growth and the polymicrobial nature of infections often delay diagnosis and treatment. This report highlights a rare case of A. europaeus infection following elective surgery. A 78-year-old woman presented with asthenia and purulent umbilical discharge two months after abdominoplasty. A CT scan revealed a large supra-fascial fluid collection. She underwent surgical debridement and lavage. Cultures identified Actinomyces europaeus, alongside Staphylococcus hominis and Staphylococcus haemolyticus. Susceptibility testing for A. europaeus was not performed. Following infectious disease consultation, therapy was switched from piperacillin/tazobactam to intravenous penicillin G, transitioning to oral amoxicillin/clavulanic acid for 12 weeks. The patient recovered fully with no recurrence. A review of the literature, highlights that A. europaeus infections are often polymicrobial, require advanced diagnostics such as MALDI-TOF (matrix-assisted laser desorption/ionization time of flight), and respond favourably to penicillin-based therapy when combined with complete surgical debridement. This case and literature review underscore challenges in managing A. europaeus and emphasize the need for increased awareness and standardized therapeutic guidelines.