[Ureteral actinomycosis. Case report].

Objectives: To report one case of pseudotumoral lesion of the iliac ureter with obstructive uropathy leading to loss of function of the renal unit.

Methods: 66-year-old male being studied for BPH who presents with a self-limited monosymptomatic hematuria.

Results: Renal ultrasound detected grade II pyelocaliectasis of the right kidney. IVU showed absence of function of the right kidney. Urine cytology was consistent with low-grade transitional cell carcinoma. Percutaneous nephrostomy was performed confirming irreversible function loss. Antegrade pyelography showed a filling defect in the right iliac ureter. Radical nephroureterectomy with bladder cuff was carried out with good results. Pathology reported chronic pyelonephritis and parietal inflammatory lesion of the ureter obliterating the lumen with inflammatory infiltrates, urothelial erosion and presence of actinomyces.

Conclusions: Actinomycosis is a chronic bacterial infection, with A. israeli being the most common pathogen. It is part of the normal flora of the oral cavity and GI tract, and cervical-facial region is the most frequent clinical involvement (60% of the cases). Urinary tract infection is exceptional. No other focus was found in the long-term follow-up.