A 53-year-old female with intrauterine contraceptive device insertion was admitted for painful abdominal mass on the left upper quadrant abdomen. Abdominal computed tomography scan showed multiple enhancing masses on the right lobe of liver, left abdominal wall and right paracolic gutter. We performed incisional biopsy on the left abdominal wall lesion. Although microorganisms were not identified, the histopathologic result was consistent with actinomycosis which contained sulfur granules within the chronic granulomatous inflammation. She was treated with penicillin agents for 6 months. We report a case of hepatic actinomycosis with abdominal wall and paracolic gutter involvement.

Actinomycosis causes a chronic suppurative, granulomatous disease which is characterized by extensive abscess formation, and sulfur granule formation. Actinomycosis may present different clinical forms: cervicofacial, thoracic, abdominal and cerebral actinomycosis. The diagnosis can only be made after surgery. In general, patients with abdominal actinomycosis have undergone abdominal surgery. We report four cases of primary appendiceal actinomycosis presenting as acute appendicitis without history of abdomen surgery.