A 64-year-old man with a history of gallstones, common bile duct stones, chronic hepatitis B virus infection, and hepatic cirrhosis with a Child-Pugh score B was satisfactorily treated for hepatocellular carcinoma with radiofrequency ablation and transarterial chemoembolization. His course, however, was complicated by gallbladder actinomycosis 14 months after treatment, resulting in acute cholecystitis. Such a chain of events suggests that gallbladder actinomycosis may develop after radiofrequency ablation and transarterial chemoembolization in patients who are known to have gallstones and that asymptomatic gallstones should be treated before the application of nonsurgical, but invasive procedures for hepatocellular carcinoma.
 Russo T. Agents of actinomycosis. In Mandell G, Bennett J, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. New York: Churchill-Livingstone, 2000. pp. 2645–2654
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