A 44-year-old patient was admitted to our hospital due to general malaise and constitutional symptoms of two weeks of evolution with weight loss of 10 kg.
She had no relevant medical history, surgical interventions or previous trauma.
The patient was a heavy smoker and drinker.
On physical examination the patient was malnourished and his denture was in poor condition.
Temperature, pulse, blood pressure, respiratory rate, head, neck and cardiac auscultation were normal.
Pulmonary auscultation revealed global hypoventilation with roncus stenosis due to both lung fields.
The abdomen showed mild hepatomegaly and a mass in the lower left quadrant, elongated, discreetly painful to palpation.
The extremities were normal.
The analysis highlighted: hemoglobin l0 g/dL, hematocrit 31%, MCV 83 fL, leukocytes 13,600/mm3 with 75% neutrophils, ESR 60 mm/hour.
Platelets, coagulation times, general biochemistry, elemental urine and sediment were normal.
The chest X-ray showed two inhomogeneous, apical-right and axillary-left sounds, with cystic lesions located inside.
Bronchoscopy was normal.
In bronchoalveolar lavage, Zhiel and Lowenstein staining were positive and Mycobacterium tuberculosis was identified.
Culture in ordinary media and cytology were negative.
Pulmonary tuberculosis was diagnosed and tuberculosis treatment with rifampicin, isoniazid and pyrazinamide was initiated.
An abdominal ultrasound showed an abdominal wall mass in the left flank, with mixed echogenicity, poorly defined, without neighboring structures.
Abdominal CT showed a 4 x 4 cm mass located between the left internal and external oblique muscles that showed a hypodense center and inhomogeneous contrast uptake.
Aspiration puncture of the mass resulted in 30 mL of purulent material in which cultures in ordinary media and Lowenstein were negative.
The cytological study showed the typical 'sulphur granules' of Actinomyces.
The patient was treated for 2 weeks with intravenous penicillin G (24 million U/day) with good clinical response.
The ultrasound performed one month later revealed the mass.
No recurrence of the mass occurred during the following 6 months.
