Journal of Postgraduate Medicine
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Year : 1986  |  Volume : 32  |  Issue : 3  |  Page : 168-70,170A  

Peri-renal actinomycosis with tuberculosis of the kidney (a case report).

HS Kulkarni, AN Dalvi, HT Nair, MS Mhaskar, SG Shenoy 
 

Correspondence Address:
H S Kulkarni





How to cite this article:
Kulkarni H S, Dalvi A N, Nair H T, Mhaskar M S, Shenoy S G. Peri-renal actinomycosis with tuberculosis of the kidney (a case report). J Postgrad Med 1986;32:168-70,170A


How to cite this URL:
Kulkarni H S, Dalvi A N, Nair H T, Mhaskar M S, Shenoy S G. Peri-renal actinomycosis with tuberculosis of the kidney (a case report). J Postgrad Med [serial online] 1986 [cited 2021 Mar 3 ];32:168-70,170A
Available from: https://www.jpgmonline.com/text.asp?1986/32/3/168/5332


Full Text



 INTRODUCTION



Actinomycosis of peri-renal tissue is an uncommon condition, and its co-existence with tuberculous lesion of the kidney is probably rare. We describe here a case treated under our care which showed the presence of both actinomycotic and tuberculous lesions.

 CASE REPORT



A 25 year old male, farmer by occupation, presented with complaints of dull ache in the left loin, graveluria and occasional hematuria since 2 years. History of low grade fever was present. No other positive history could be elicited. Examination of the patient was normal. Haemoglobin was 11 gm%, ESR was 108 mm in the first hour. Other biochemical investigations were normal. Urine examination showed mild proteinuria and acidic pH. Urine culture showed presence of acid fast bacilli. Radiograph of the chest was normal. Radiograph of the abdomen showed a calcific shadow in the region of the left kidney. Intravenous urography revealed non-functioning left kidney with normal function on the right side [Fig. 1]. Bladder was normal.

The patient was treated with antituberculous drugs consisting of rifampicin, INH and ethumbutol for six weeks and subjected to surgery. At operation, dense perirenal adhesion made subcapsular nephrectomy with ureterectomy necessary. The kidney was small and had multiple cavities, filled with caseous material.

Histopathology confirmed the diagnosis of tuberculosis of kidney but also showed actinomycotic affection of the perirenal tissue. [Fig. 2].

The patient was put on penicillin with antituberculous drugs. Post-operative course was uneventful. Barium study was carried out to look for evidence of intestinal actinomycosis. All radiographs were normal. The patient was followed up for two months, but had no complaints. Urine was negative for both acid fast bacilli and actinomyces.

 DISCUSSION



Actinomycosis is a chronic inflammatory process caused by anaerobic Actinomyces Israeli. It is normally found as a harmless inhabitant of the oral cavity,[1],[2] intestine and appendix. Disease process probably occurs as a result of penetration by organism through a breach in the mucosa due to trauma, infection or surgery. The diagnosis of actinomycosis is usually achieved postoperatively when pus with typical sulphur granules begins to discharge from the wound site.[6] Growth of the organism, according to Holm[7] is facilitated by concomitant bacterial infection due to decrease in oxygen tension of the involved tissues. Spread of actinomycosis is by direct route. Hematogenous spread is rare. Lymphatics are considered immune. Common sites of affection are the cervico-facial area (63%) and thoracic region (13-15%).[9] Other sites are rare.

Wilson-Pepper[14] reported involvement of kidney in three-forms (i) chronic suppurative lesion presenting as a carbuncle, (ii) pyelonephritis, and (iii) pyonephrosis. Yu et al[15] reported a case of primary renal actinomycosis with reno-colic fistula in 1978. Weese et al,[13] in reviewing 57 cases, sited involvement of ureters, adrenals and testes. Vesical actinomycosis has been described in literature as secondary to intrauterine devices[8] or Madura foot.[5] Fanous et al[4] reported perivesical actinomycosis ill a case presenting as acute abdomen. Schiffer et al11 reviewed more than 300 cases of actinomycosis of the female genital tract secondary to intra-uterine contraceptive devices. Affection of the scrotum was described by Sarosdy et al[10] in 1979. Deodhar et al[3] reported a case of primary abdominal wall actinomycosis in 1984.

Penicillin is regarded to be the drug of choice. Successful reports with aureomycin,[12] surgery and ampicillin1 have been noted.

In our study, since the patient also had coexistant tuberculosis, both penicillin and antituberculous drugs were used. At two months' follow-up, the patient was asymptomatic and in good health.

 ACKNOWLEDGEMENT



We are thankful to the Dean, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012, for allowing us to publish this hospital data.

References

1Anhalt, M. and Scott, R. Jr.: Primary unilateral renal actinomycosis, case report: J. Urol., 103: 126-129, 1970.
2Cecil, H. L. and Hill, J. H.: Actinomycosis of the urinary organs: J. Amer. Med. Assoc., 78: 575-578, 1922.
3Deodhar, S. D., Shirahatti, R. G. P. and Vora, I. M.: Primary actinomycosis of the anterior abdominal wall. J. Postgrad. Med. 30: 133-134, 1984.
4Fanous, H., Elist, J, and Edson, M.: Perivesical actinomycosis presenting as an acute abdomen: J. Urol. 126: 117-118, 1981.
5Hatch, W. E. and Wells, A. H.: Actinomycosis of the urinary bladder complicating a case of Madura foot: J. Urol. 52: 149-152, 1944.
6Hertz, J.: Actinomycosis. Oral, facial and maxillary manifestations. J. Internat. Coll. Surg., 28: 539-556, 1957.
7Holm, P.: Studies of the etiology of human actinomycosis: the 'other microbes' of actinomycosis and their importance. Acta. Pathol. Microbiol. Scandinav., 27: 736-740, 1950.
8King, D. T. and Lam, M.: Actinomycosis of the urinary bladder: associated with an intra-uterine contraceptive device. J. Amer. Med. Assoc. 240: 1512-1513, 1978.
9Macoul, K. and Souliotis, P.T.: Actinomycosis: solitary nodule. Postgrad. Med., 42: 288-290, 1967.
10Sarosdy, M.F., Brock, W.A. and Parsons, C.L.: Scrotal actinomycosis. J. Urol. 121: 256-257, 1979.
11Schiffer, M.A., Elguezabal, A., Sultana, M. and Allan, A.: Actinomycosis infections associated with intrauterine contraceptive devices. Obstet. & Gynaecol., 45: 67-72, 1975.
12Svane, S.: Visceral actinomycosis, Report on six cases with special reference to aureomycin treatment: Acta Chir. Scandinav., 131: 160-166, 1966.
13Weese, W. C. and Smith, I. M.: A study of 57 cases of actinomycosis over a 36 year period. A diagnostic 'failure' with good prognosis after treatment. Arch. Int. Med., 135: 1562-1568, 1975.
14Wilson-Pepper, J. K.: Report on renal actinomycosis: J. Urol. 62: 410-416, 1949.
15Yu, H.H.Y., Yim, C.M. and Leong, C.H.: Primary actinomyosis of kidney presenting with reno-colic fistula. Brit. J. Urol., 50: 140, 1978.

 
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