A Patient with Appendiceal Actinomycosis Who Presented with Hydronephrosis

Abstract

A 24-year-old male patient visited his neighborhood hospital with a history of dysuria and right lower abdominal pain. He received treatment with oral antibiotics for one month, but the symptoms failed to resolve. He was referred to our hospital and diagnostic imaging conducted at our hospital showed a swollen appendix surrounded by inflamed ileocecal visceral fat and right hydronephrosis. The diagnosis of appendicitis was made and emergent appendectomy was performed. The postoperative course seemed uneventful and the patient was discharged from the hospital on the fifth day after surgery. Histopathological examination of the resected specimen after the patient was discharged revealed the diagnosis of actinomycosis. Three days after discharge, the patient presented to the emergency room with fever and abdominal pain. He was diagnosed as having a residual abscess and treated with intravenous penicillin for two weeks, followed by oral minomycin for four weeks. Abdominal actinomycosis presenting with urinary symptoms is relatively rare. It would be useful to consider this diagnosis in patients with atypical presentations of appendicitis, to avoid readmission or inadequate antibiotic therapy.