|Year : 2003 | Volume
| Issue : 2 | Page : 159-160
Actinomycosis of urinary bladder - a rare entity
Chaman Lal Gupta, Rahul Gupta
Department of Urology, Batra Medical College and Hospital, Jammu, India
Chaman Lal Gupta
Urology, 3 D/D Ilnd EXT, Green Belt Park, Jammu - 180 004
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Actinomycosis is considered the most misdiagnosed disease usually involving the cervico fascial region, thorax, abdomen and occasionally also the pelvis, usually in case of the females using intra-uterine devices. The involvement of the urinary tract is rare and primary actinomycosis of urinary bladder is still rarer. The disease is usually diagnosed by demonstration of the discharged sulphur granules. In our case this was not the usual presentation and the patient was first diagnosed as having appendicular mass and then bladder malignancy. The excised mass demonstrated features suggestive of actinomycosis.
Keywords: Actinomycosis, urinary bladder
|How to cite this article:|
Gupta CL, Gupta R. Actinomycosis of urinary bladder - a rare entity. Indian J Urol 2003;19:159-60
| Introduction|| |
Actinomycosis of the urinary tract is a rare and primary actinomycosis of urinary bladder is still rarer. We report a case of primary actinomycosis of urinary bladder.
| Case Report|| |
A 27-year-old male was referred from Leh district with history of repeated pain in lower abdomen, dysuria and haematuria for last 6 weeks. Examination revealed a nodular mass in the right lower abdomen and the same was treated as appendicular lump. The patient's investigations showed haemoglobin 14 gms %, TLC-7600 mm, 3 DLC P-66 L-29, M-30, E-02; bleeding time 2 min 50 secs, clotting time 4 min 50 sec. Urine examination showed RBCs. Ultrasound showed an intravesical mass 26x45 mm at the right anterolateral wall at the dome of the bladder [Figure - 1]. Cystoscopy showed a mass 3x4 cms projecting from superior surface of bladder much away from the ureteric orifices. CT scan showed localized thickening of the anterior wall of urinary bladder with specks of calcification [Figure - 2]. There was obliteration of perivesical fat plane in some areas. Prostrate and seminal vesicles were normal.
Till this stage the investigation suggested a diagnosis of bladder tumour with extravesical extension. Surgery was planned and the mass was excised along with perivesical fat and 2 cm cuff of normal bladder. The excised tissue was sent for histopathology examination, which revealed actinomycosis [Figure - 3].
| Comments|| |
Actinomycosis is an indolent and slowly progressive chronic granulomatous infection. It is characterized by the development of indurated swellings, mainly in the connective tissue, suppuration and discharge of sulphur granules.  Rarely the disease involves the genitorurinary system, usually by the haematogenous route from a primary site of infection.  Urinary bladder may also be involved by a direct extension from the adjoining structures like bowel, oviduct.  Primary infection of urinary bladder has been reported. 
Clinically there is nothing pathognomonic about actinomycosis and the diagnosis is made on the demonstration of sulphur granules and culture.  Treatment requires removal or debridement of the infected tissue and the use of antibiotics. 
In the case described the patient was a young male, smoker, and had features of fever and right-sided mass, so he was first treated as a case of appendicular mass, to which he did not respond. Further investigations were undertaken which suggested malignancy. So he was taken up for a partial cystectomy. The histopathology revealed features of actinomycosis and he was put on oral ampicillin. His postoperative period has been uneventful.
| References|| |
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|2.||Emil A Tanagho. Specific infection of genitourinary tract. In Smith's General Urology, 15th ed. Emil A Tanagho, Jack W McAninch (eds). McGraw-Hill Company 2000; 273. |
|3.||Gilbert J Wise. Fungal infections of the urinary tract. In Campbell's Urology, 7th ed. Walsh PC, Retik AB, Vaughan Jr DE, Wein A J (eds). WB Saunders 1990; 797. |
|4.||Makar AP, Michielsen JP. Boeckk GJ, Vamarck EA. Primary actinomycosis of urinary bladder. Br J Urol 1992; 70: 205-206. |
[Figure - 1], [Figure - 2], [Figure - 3]