PMC9241052_01
CT of the chest with contrast revealed right upper lobe (RUL) heterogeneous enhancing mass (red arrows) and scattered bilateral nodules <6 millimeters (transparent red rings).
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Contrasted computed tomography (CT) of the chest, abdomen, and pelvis revealed right upper lobe (RUL) heterogeneous enhancing mass and scattered bilateral nodules < 6 millimeters (Fig. 1), right iliac diffuse permeative appearance, extensive complex septated acute collections within the right iliopsoas region, deep right gluteal region and the right paraspinal musculature from the L4 - S2 levels.
MRI of the pelvis and lumbar spine with and without contrast revealed a large multilobulated cystic mass 17 x 11.8 x 10.5 cm (red arrow) centered around the right iliac bone (blue arrow) with extension medially into portions of the iliopsoas muscle, laterally into the adjacent gluteal musculature, and posterosuperiorly into the posterior paraspinal musculature.
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Magnetic resonance imaging (MRI) of the pelvis and lumbar spine with and without contrast revealed a large multilobulated cystic mass centered around the right iliac bone with extension medially into portions of the iliopsoas muscle, laterally into the adjacent gluteal musculature, and posterosuperiorly into the posterior paraspinal musculature (Fig. 2).
Right pelvic fluid collection revealing bacterial colonies most consistent with Actinomyces.
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The aspirated purulent fluid showed extensive necroinflammation, bacterial colonies most consistent with Actinomyces (Fig. 3) and no malignant cells.
(A). Right pelvic fluid histopath revealed Splendore-Hoeppli phenomenon [Sulfur granules (Clumps of bacterial forms with a basophilic center (red star), eosinophilic periphery (pink star) and associated inflammation (blue star). (B). Sulfur granule revealing swollen terminal process or clubs with proteinaceous debris and eosinophilic material (Antigen-antibody complexes and debris from the inflammatory cells of the host).
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Right pelvic fluid histopath revealed the Splendore-Hoeppli phenomenon (sulfur granules and associated inflammation) (Fig. 4). An oral dental surgeon evaluated his bad oral hygiene (Fig. 4).
Oral cavity revealing poor oral hygiene with extensive dental caries and tooth decay.
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He completed 12 months of oral amoxicillin with complete recovery. (Fig. 5).