A CASE REPORT ON PRIMARY GASTRIC ACTINOMYCOSIS

Abstract

Primary gastric actinomycosis is an extremely rare condition, and just over 20 cases have been reported in the literature. In most cases, the diagnosis was made by performing histopathological examination of surgical specimens. We report on a 37-year-old woman with B-cell prolymphocytic leukemia who underwent second-line chemotherapy. After 2 weeks, she developed nausea and epigastralgia. Esophagogastroduodenoscopy (EGD) revealed a large ulceration, mucosal edema, and thickening of the gastric lining. Histopathological examination of biopsy specimens obtained by endoscopy revealed actinomycotic granules with typical features of Actinomyces species. Gastric actinomycosis was diagnosed, and the patient underwent treatment with an intravenous dose of ABPC/SBT for 35 days and a subsequent oral dose of AMPC. EGD findings at 65 days after treatment revealed disappearance of both ulceration and thickening of the gastric mucosal lining. The patient was discharged, but the antibiotherapy was continued. A Definitive diagnosis of primary gastric actinomycosis wihtout surgical treatment is relatively difficult because there are no specific endoscopic findings for this condition ; the endoscopic findings may sometimes indicate a malignant tumor. Furthermore, histopathological examination of biopsy specimens may not often provide typical and suspicious findings of the disease. The ideal duration and selection of the standard antibiotherapy for actinomycosis have not yet been established. Antibiotherapy was continued for almost 6-12 months in the reported cases. We report this case on account of its rarity with regard to the diagnosis of primary gastric actinomycosis based on endoscopic findings and promising results of conservative therapy with antibiotics.