See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/6718962 A new form of presentation of renal actinomycosis: Renal tumor with retroperitoneal bleeding Article in Archivos españoles de urología · October 2006 DOI: 10.4321/S0004-06142006000700018 · Source: PubMed CITATIONS READS 4 58 8 authors , including: Antonio Jalon Monzon Miguel Alvarez-Múgica University of Oviedo Hospital Valle Del Nalon 155 PUBLICATIONS 234 CITATIONS 87 PUBLICATIONS 394 CITATIONS SEE PROFILE SEE PROFILE Jesus M Fernández-Gómez University of Oviedo 284 PUBLICATIONS 1,980 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Personal training View project Tugamo study View project All content following this page was uploaded by Jesus M Fernández-Gómez on 17 February 2014. The user has requested enhancement of the downloaded file.
International Section CONCLUSIONES: La actinomicosis renal es una in- Resumen.- OBJETIVO: El objetivo de este artículo es añadir que en una forma de presentación nunca antes sido publicada: tumor renal con sangrado retroperito- neal. MÉTODOS: Presentamos el caso de una mujer de 27 años con síndrome constitucional y dolor en flanco dere- cho de cinco meses de evolución. Las pruebas radiológi- cas mostraron un tumor renal derecho con sospecha de sangrado retroperitoneal. Se realizó nefrectomía radical derecha y el estudio patológico encontró colonias de actinomices. El paciente recibió penicilina durante ocho semanas después de la cirugía y no tuvo secuelas. fección crónica poco frecuente producida por actino- chronic infection caused by a gram-positive anaerobic mices, generalmente actinomices israelii, una bacteria gram positiva anaerobia de difícil diagnóstico debido a los hallazgos clínicos y radiológicos inespecíficos. Es importante diagnóstico precoz de la actinomicosis renal para evitar la cirugía, puesto que el actinomices respon- de bien a altas dosis de penicilina. Keywords: Renal actinomycosis. Chronic infection. Penicillin. easily diagnosed because of non-specific clinical and radiological findings. Early diagnosis of renal actinomycosis is important to avoid surgery since actinomyces respond well to high doses of Penicillin. Palabras clave: Actinomicosis renal. Infección actinomyces bacteria, usually actinomyces israelii, not CONCLUSIONS: Renal actinomycosis is an uncommon Arch. Esp. Urol., 59, 7 (756-759), 2006 33006-Oviedo. Asturias. (Spain) A NEW FORM OF PRESENTATION OF RENAL ACTINOMYCOSIS: RENAL TUMOR WITH RETROPERITONEAL BLEEDING. Antonio Jalón Monzón 1 , Miguel Álvarez Múgica 1 , Miguel Ángel Seco Navedo 2 , Jesús Maria Fernández Gómez 1 , Verónica Bulnes Vázquez 3 , Roberto Carlos González Álvarez 1 , Francisco Javier Martínez Gómez 1 y Francisco Javier Regadera Sejas 1 . 1 Urology Department. Hospital Universitario Central de Asturias. Oviedo. Spain. 2 Anatomic Pathology Department. Hospital Universtario Central de Asturias. Oviedo. Spain. 3 Radiology Department. Hospital Universitario Central de Asturias. Oviedo. Spain. Correspondence to: Antonio Jalón Monzón Servicio de Urología 1 Hospital Universitario Central de Asturias C/ Celestino Villamil s/n ajalonm@hotmail.com Penicillin after surgery and had none sequelae. Accepted for publication: 1st January, 2006 Summary.- OBJECTIVE: The aim of this case report is to add to the literature a new case of renal actinomycosis, but with a form of presentation that has never been reported: renal tumor with retroperitoneal bleeding. METHODS/RESULTS: We present the case of a 27 year old woman, with a 5-month history of general syndrome and right flank pain. Radiological findings showed a right renal tumor with suspicious of retroperitoneal bleeding. Right radical nephrectomy was performed and the pathological examination of the specimen found actinomyces colonies. The patient received 8 weeks of crónica. Penicilina.
A. Jalón Monzón, M. Álvarez Múgica, M. A. Seco Navedo y cols. retroperitoneal bleeding (Figure 1) and multiple bilateral Right nephrectomy was performed. The right kidney sputum cultures were negative as well as tumor markers. selective angiography (Figure 3). Blood, urine and evidence of active bleeding was demonstrated in and chronic right renal vein thrombosis without pulmonar nodules (Figures 2). Neovascularization and tomography yielded a right renal mass with was very difficult. Pathological examination showed (hemoglobine 6.1 g/dl). Abdominal ultrasonography was detected. Laboratory tests showed severe anaemia physical examination a palpable abdominal mass a weight loss of 8-10 kg and right flank pain. On health, presented a 5-month history of general fatigue, A 27 years old woman previously in good was firmly adherent to adjacent tissues and dissection fibrous tissue with mixed acute and chronic inflammatory CASE REPORT DISCUSSION FIGURE 2. Chest CT. Multiple bilateral pulmonary peritoneal bleeding. FIGURE 1. Abdominal CT. Right renal mass with retro- infection with a worldwide distribution (1). Actinomyces Actinomycosis is a chronic granulomatous spread. cells. There were also multiple microabscesses. On was probably oral with thoracic and finally abdominal intraabdominal etiology was identified, the origin actinomycosis can only be hypothesized. Since no (Figure 4). In this patient the source and spread of appearance consistent with actinomycosis was found gram-positive bacteria with a “sulfur granule” further microscopic evaluation a branching, filamentous, 757 israelii, a gram-positive anaerobic microorganism, is disease), previous surgery (post-appendectomy abdominal may include abdominal pain, urinary frequency or entity. Clinical findings are usually non specific and Genitourinary actinomycosis is a very rare dental hygiene (cervico-facial disease) (4). actinomycosis), dental extraction, trauma and poor term use of contraceptive intrauterine devices (pelvic between the onset of symptoms and diagnosis. The include diabetes mellitus, immunosupression, long viscous perforation or surgery (2,3). Predisposing factors disease under special circumstances, during trauma, mouth, tonsils and gastrointestinal tract, causing human, actinomyces is a harmless saprophyte in the the most common pathogenic agent involved. In the repetitive cystitis. Generally, there is a long term interval diagnosis is primarily histological identification. Cultures completely. Four type of renal lesions have been involved the original lesions might have dissapeared dissemination also occurs. By the time the kidney is and aspiration of infected material, hematogeneous contiguous structures such as lungs or colon, (1,5,6) is still controversial. In addition to direct spread from The route of infection in renal actinomycosis prostatitis, penile pilonidal sinus and cystitis (10). are often unsuccessful in determining causative factors, retroperitoneal mass, ureteral stenosis, scrotal mass, Other manifestations of actinomyces have been reported: (7), reno-duodenal fistula (8) and reno-colic fistula (9). renal infection (1,2,5,6), including a horseshoe kidney genitourinary tract, actinomyces can cause primary being positive in less than 50 % of cases (1,5). In the nodules.
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