Case report:  A 50 year old man presented with weight loss, fever and multiple hepatic masses on ultrasound examination.  Thirteen years prior to admission, the patient had undergone total pancreatectomy and splenectomy for chronic painful alcoholic pancreatitis resulting in pancreatic exocrine insufficiency and diabetes.  Cytologic examination of an ultrasound-guided biopsy of the largest hepatic mass revealed the presence of actinomyces.  The patient was treated with high dose IV penicillin for 6 weeks followed by oral penicillin for several months and he became asymptomatic.  Seven years later, he presented with fever, night sweats, weight loss, pulmonary infiltrates and an 8 cm liver mass.  A liver biopsy showed an inflammatory pseudotumor, but was otherwise unrewarding.  A lung biopsy uncovered the presence of actinomyces.  He became asymptomatic after high dose IV penicillin treatment, but life-long treatment with oral penicillin was undertaken.  Discussion: Primary hepatic actinomycosis is a rare entity.  Liver involvement is  reported in 5% of all patients with actinomycosis, and in 15% of cases with abdominal involvement.  The lesions develop after appendicitis or surgery for non-inflammatory diseases in most instances, but there are reports wherein the pathogenesis is unclear, such as in the present case.  Recurrence and spread of infection 7 years after appropriate treatment suggests that life-long antibiotic therapy may be required to eradicate or at least contain the infection.

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