[Abdominal actinomycosis after stomach surgery in a patient with long-term rheumatoid arthritis treated with methotrexate].
METHODS
A 78-year-old woman had a 30-year history of rheumatoid arthritis, of late treated with prednisolone and methotrexate. A week before admission she had first noticed a mass about 3 cm in diameter, at the lower end of a scar from a Billroth II gastric resection for gastric ulcer, performed 4 months before. She reported to have lost 6.5 kg in weight. On admission a moderately mobile, hard mass was palpated on the abdomen.


METHODS
Ultrasound and computed tomography revealed a superficial, inhomogenous space-occupying lesion with poorly circumscribed margins.


METHODS
After two days the skin over the mass became reddened and a laparotomy was performed because an incarcerated herniation was suspected. An abscess and inflammatory adhesions were found in the area of the transverse colon, histologically shown to be a chronic purulent abscess with granular clusters of pathogens indicating actinomycosis. After 3 weeks' treatment with imipenem i.v. the patient became free of symptoms, oral doxycyclin was continued for a further 6 months.


CONCLUSIONS
Actinomycosis should be considered in the differential diagnosis of a tumour of undetermined benignity in the region of the head, chest or abdomen in immunosuppressed patients. This bacterial infection should be thought of especially if the gastrointestinal mucosa has been penetrated by invasive procedures.
Jung
C
C
Abteilung für Allgemeine Innere Medizin, Medizinischen Klinik und Poliklinik.
Wagner
J
J
Heine
B
B
Sieper
J
J
Distler
A
A
Braun
J
J
D018784:Abdominal Abscess / Q000175:diagnosis*; D000196:Actinomycosis / Q000175:diagnosis*; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000175:diagnosis*; D011178:Postgastrectomy Syndromes / Q000175:diagnosis*; D012307:Risk Factors; D013276:Stomach Ulcer / Q000601:surgery
D018501:Antirheumatic Agents; D008727:Methotrexate