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On exam, he was afebrile, had a blood pressure of 85/70 mmHg, and an oxygen saturation of 84% on room air. The patient had poor dentition, decreased breath sounds bilaterally, and multiple abdominal masses palpable in the left lower quadrant and along the liver border. Labs were remarkable for an elevated lactate of 2.3 mmol/L, hemoglobin of 7.6 g/dL, and albumin level of 1.9 g/dL. His white blood cell (WBC) count and arterial blood gas were within normal limits. Imaging revealed a large right-sided pleural effusion with septations and complete collapse of the right lung (Figure 1), as well as multiple intra-abdominal abscesses with air-fluid levels.

Abdomen Actin’ Up: A Unique Presentation of Disseminated Abdominal Actinomycosis