RENAL ACTINOMYCOSIS--A CASE REPORT/BUBREZNA AKTINOMIKOZA--PRIKAZ SLUCAJA

• Published in: Medicinski pregled Vol. 72; no. 7-8; p. 243
• Main Authors: Popov, Mladen, Vojinov, Sasa, Levakov, Ivan, Grbic, Dragan, Jeremic, Dimitrije, Popov, Iva
• Format: Journal Article
• Language: English
• Published: Drustvo Lekara Vojvodine 01-07-2019
• Subjects: Abscess; Antibiotics; Bacteria; Cefepime; Cephalosporins; Corticosteroid drugs; Diagnosis; Histochemistry; Hospital emergency services; Kidney diseases; Lymphocytes; Macrophages; Penicillins; Pets; Surgery; Urinalysis; Urinary tract infections; Vasculitis
• ISSN: 0025-8105
• DOI: 10.2298/MPNS1908243P

Introduction. Actinomycosis of the urogenital tract mainly manifests with formation of renal and perirenal abscesses. When it comes to treating renal lodge abscesses caused by Actinomyces bacteria, the method of choice is mainly surgical evacuation of purulent collections, followed by administration of parenteral penicillin or cephalosporin antibiotics during a six week period. The definitive diagnosis is made based on the antibiogram findings, isolation of Actinomyces israelii from abscess collection, as well as by characteristic histological findings. The exact incidence and prevalence of urogenital actinomycosis is still unknown. Case Report. A 54-year-old female patient was admitted to the Emergency Department of the Clinical Center of Vojvodina for triage. She complained of pain in the left lumbar and gluteal region, weakness, malaise, and fever. She was treated with corticosteroids under the diagnosis of vasculitis five months prior to admission. Based on clinical, laboratory blood and urine tests, ultrasound examination of the abdomen and contrast CT of the abdomen and pelvis, the diagnosis of left kidney abscess was made. It also spread to the retroperitoneum (iliopsoas muscle, gluteus maxuimus and ipsilateral inguinal region). Urgent operative exploration of retroperitoneum and kidney was performed. A lumbotomy was performed in the left half of the retroperitoneum with evacuation of abscesses, as well as partial nephrectomy of the lower half of the left kidney. Subsequently, the obtained antibiogram of operatively sampled aspirate, renal actinomycosis was histopathologically verified. The surgically removed tissue that was sent for histopathology showed presence of connective tissue infiltrated with a pronounced inflammatory infiltrate composed of lymphocytes, plasma cells, histiocytes and granulocytes with numerous microabscesses and actinomycosis colonies. Key words: Actinomycosis; Kidney Diseases; Abscess; Retroperitoneal Space; Urinary Tract Infections; Diagnosis; Signs and Symptoms; Urologic Surgical Procedures Uvod. Na nivou urogenitalnog trakta aktinomikoza se uglavnom manifestuje stvaranjem renalnih i perirenalnih apscesa. Metoda lecenja apscesa bubrega i bubrezne loze, koji su uzrokovani baketrijama iz genusa Actinomyces, jeste hiruska evakuacija gnojne kolekcije uz parenteralnu terapiju penicilinima ili cefalosporinskim antibioticima u trajanju od sest nedelja. Definitivna dijagnoza se postavlja na osnovu nalaza biograma i izolacije Act. israelii iz apscesne kolekcije kao i na osnovu karakteristicnog patohistoloskog nalaza. Tacna incidencija i prevalencija urogenitalne aktinomikoze nije poznata. Prikaz slucaja. Pacijentkinja starosti 54 godine javila se u Trijaznu ambulantu Urgentnog centra Klinickog centra Vojvodine zbog bolova u predelu leve lumbalne i glutealne regije, slabosti, malaksalosti i febrilnosti. Poslednjih pet meseci lecena je kortikosteroidima kod imunologa, pod dijagnozom vaskulitisa. Na osnovu klinicke slike, laboratorijskih nalaza krvi i urina, ultrazvucnog pregleda abdomena i kontrasne kompjuterizovane tomografije abdomena i male karlice postavljena je dijagnoza apscesa levog bubrega koji iradira u retroperitoneum, u m. iliopsoas, m. gluteus maxuimus i ingvinalnu regiju ipsilateralno. Izvrsena je hitna operativna eksploracija retroperitoneuma i bubrega. Lumbotomijom je pristupljeno levoj polovini retroperitoneuma uz evakuaciju apscesa i ektomiju donjeg pola levog bubrega. Naknadno je dobijen nalaz biograma sa antibiogramom operativno uzorkovanog aspirata i patohistoloske verifikacije da se radi o aktinomikozi bubrega. U patohistoloskom nalazu tkiva koje je operativno odstranjeno bilo je prisutno vezivno masno tkivo sa izrazenim zapaljenskim infiltratom koji je sastavljen od limfocita, plazmocita, histiocita i granulocita sa brojnim mikroapscesima i kolonijama aktinomikoze. Kljucne reci: aktinomikoza; bolesti bubrega; absces; retroperitonealni prostor; infekcije urinarnog trakta; dijagnoza; znaci i simptomi; uroloske hirurske procedure