Hepatic Actinomycosis: A Diagnostic Challenge.

BACKGROUND

Primary hepatic actinomycosis (HA) is a rare chronic abscess-forming infection caused by an anaerobic gram-positive filamentous bacillus of the genus Actinomyces. It is a great imitator of liver tumors.

CASE REPORT: We describe two patients who presented space-occupying lesions in the liver after hepaticojejunostomy. In the first case, hepaticojejunostomy was performed for recurrent choledocholithiasis. He later developed a left lobe abscess with hepaticolithiasis for which left hepatectomy with re-do hepaticojejunostomy was performed. His postoperative histology demonstrated actinomycosis. The second patient, a postoperative follow-up case of Whipple's procedure, developed sequentially bilateral liver abscesses with chronic discharging sinus. HA was diagnosed by percutaneous biopsy, and he recovered with a prolonged course of antibiotics.

CONCLUSION

Hepatic actinomycosis is a rare disease with frequent misdiagnosis and a protracted course of illness with a subacute or chronic inflammatory presentation. A high index of suspicion is required to avoid major liver resection, particularly in patients with prior hepaticojejunostomy. The definitive diagnosis is done by histopathology and can be cured with antibiotics.