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This 63-year-old man sought medical attention for abdominal pain of six months’ duration. He also had experienced the recent onsetof a gritty yellow discharge from his umbilicus.
On physical examination, this patient had findings that, when taken together, are virtually pathognomonic of actinomycosis: anerythematous, indurated, and tender soft tissue mass in the right paracervical area (“lumpy jaw”); a similar mass in the right axilla; and an indurated,discolored umbilicus with a draining sinus therein. Another draining sinus was evident in the sternum. Cultures of these drainages grew Actinomyces israelli . During a year of penicillin therapy, all of the aforementioned abnormalities resolved.
One other point: This patient also had erythema ab igne (arrows, image below), a permanent brown to red, reticulated, residualpigmentation produced by prolonged exposure to excessive nonburning heat. It came about in this man from his use of a heating pad to relieve the abdominalpain.
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