Actinomycosis is a granulomatous disease caused by Actinomyces that mimics other intra-abdominal pathologies especially neoplasms. Correct diagnosis can be rarely established before radical surgery. On the other hand Entamoeba infection affects a considerable number of people worldwide. To our knowledge only one case has been reported to be affected by both organisms. We report a man who has been operated for a mass in the cecum mimicking a perforated colon cancer. Abdominal CT revealed a mass with features of an invading neoplasm. After radical surgery, definitive pathology revealed that the mass was due to actinomycosis associated with Entamoeba infection. The postoperative period was uneventful and the patient was on long-course antibiotherapy. It is important to consider actinomycosis especially in patients with intra-abdominal masses with unusual aggressiveness to prevent unnecessary surgery. However, surgery can be unavoidable especially in the presence of complicated disease or high index of suspicion for malignancy. 1. Introduction Actinomyces is an anaerobic, gram-positive saprophytic organism normally present in the gastrointestinal tract, female genital tract, and bronchus [1]. It is not always pathologic but it may lead to chronic infectious diseases with destruction of muscular barrier by trauma, endoscopic manipulations, previous operations, gastrointestinal foreign body, and infections like appendicitis [1–3]. The infection is facilitated by immunosuppressive conditions like leukemia, lymphoma, renal transplant, and diabetes [4]. Bowel obstruction and perforation without predisposing factors are very rare and only a few cases have been described in the literature [3]. The clinical course is indolent and a malignant tumor-like appearance makes differential diagnosis difficult that leads to a delay in treatment [1]. On the other hand, Entamoeba infections are prevalent worldwide and the clinical course may vary from asymptomatic states to “amebomas” which are exophytic, cicatricial, and inflammatory masses due to longstanding and partially treated infections. These are seen in only 1.5% of patients with amebiasis [5]. The differentiation of these masses from Crohn’s disease, abscesses due to perforated appendicitis, colon cancer, and diverticulosis is important for early diagnosis and treatment [5, 6]. To our knowledge the presence of Entamoeba in a mass formed by Actinomyces infection has not been reported in the literature and the only report regarding the association of these two microorganisms is by Arroyo who wrote about an
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