PMC9997601_01
(a and b) Contrast-enhanced CT Abdomen: Coronal and axial images showing fluid-filled distended [21 mm in diameter] appendix containing two calcific appendicoliths with annular mural thickening and hyperenhancement (arrowed), (c and d) Showing the thickened base of the appendix (arrowed)
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F1
C-reactive protein level of 2.5 mg/L. Computed tomography (CT) of the abdomen was suggestive of acute retrocecal appendicitis without any regional lymphadenopathy [Figure 1a and 1b]. The cecal pole was especially thickened disproportionate to the extent of surrounding inflammation [Figure 1c and 1d].
(a) Focus of actinomycosis with surrounding inflammatory cells (arrowed, H and E stain, original magnification x10), (b) Gram-positive actinomycotic colony (arrowed, gram stain, original magnification x10), (c) Acid-fast negative bacteria (acid-fast stain, original magnification x10), (d) Focus of actinomycosis with surrounding inflammatory cells (arrowed, H and E stain, original magnification x100
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F2
Special stains showed gram-positive and acid-fast negative filamentous organisms consistent with actinomycosis [Figure 2 a-d].