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Images of Memorable Cases: Case 153

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

http://rup.rice.edu/memcases-button.jpg

Case_153-pres1-1.jpg

This 63-year-old man sought medical attention for abdominal pain of six months’ duration. He also had experienced the recent onset of a gritty yellow discharge from his umbilicus.

153. Disseminated actinomycosis

On physical examination, this patient had findings that, when taken together, are virtually pathognomonic of actinomycosis: an erythematous, indurated, and tender soft tissue mass in the right paracervical area (“lumpy jaw”); a similar mass in the right axilla; and an indurated, discolored umbilicus with a draining sinus therein. Another draining sinus was evident in the sternum. Cultures of these drainages grew Actinomyces israelli. During a year of penicillin therapy, all of the aforementioned abnormalities resolved.

One other point: This patient also had erythema ab igne (arrows, image below), a permanent brown to red, reticulated, residual pigmentation produced by prolonged exposure to excessive nonburning heat. It came about in this man from his use of a heating pad to relieve the abdominal pain.

Case_153-diag1-1.jpg

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