Primary Gastric Actinomycosis: a Rare Case Report

Actinomycosis is a chronic disease characterized by abscess formation, tissue fibrosis, draining sinuses and ulcers. It is caused by the filamentous, gram-positive anaerobic or microaerophilic bacterial species of the genus Actinomyces. Actinomycosis mainly presents in three forms: cervicofacial (31-65%), abdominopelvic (2036%) and thoracic (15-30%). Abdominal actinomycosis has often been called “one of the greatest imitators in clinical practice”. It often presents as an indolent chronic suppurative process with atypical symptoms that are misdiagnosed as neoplasms and other inflammatory diseases like tuberculosis or Crohn’s disease. There is a predilection for appendix and ileocecal region of the bowel and thus, it can easily mimic colonic adenocarcinoma, intestinal tuberculosis, chronic appendicitis or regional enteritis. When outside the intestine, abdominal actinomycosis generally grows by local spread with rare incidences of haematogenous or lymphatic dissemination. Primary gastric actinomycosis is extremely rare, with only 24 cases reported till date. The rarity of gastric involvement by Actinomyces spp. has been attributed to the high luminal acidity of stomach, as a result of which, the organisms are either killed or their growth is inhibited. We hereby present a case of primary gastric actinomycosis, which to the best of our knowledge, is the first ever report from India.