Publication:

Interesting case discussion of a lesion over the right abdominal wall

A diagnosis of hepatic actinomycosis is challenging and often overlooked because of its indiscernible nature and slow rate of progression. This is further complicated with absence of any specific clinical and radiologic manifestations. In this case, a 49 years old male, farmer, with no co-morbidities or significant past medical or surgical history, reported to the department of surgery, with complains of non-healing ulcer over right upper abdomen since five months. Examination of the ulcer led to a clinical suspicion of a malignant lesion. Sonogram of abdomen and pelvic region, which revealed heterogenous lesion with central necrosis in the right lumbar region of the abdominal wall with extension into the skin surface, a heterogenous lesion noted on the liver, and right pleural effusion with the suggestion to consider the possibility of primary skin/abdominal wall tumor with hepatic metastasis with right pleural effusion. Further investigation was performed using contrast enhanced CT scan which also favoured the diagnosis of a malignancy. However, biopsy of the skin lesion was negative for malignancy and it confirmed the diagnosis of Actinomycosis. This diagnosis was further confirmed with an ultrasound guided biopsy of the liver lesion. The patient was then started on appropriate treatment for the same and he recovered well.