Atypical Presentation of Ileal Actinomycosis Mimicking a Neuroendocrine Tumor: A Case Report

We report a diagnostically challenging case of ileal actinomycosis in a 43-year-old woman presenting with features of subacute intestinal obstruction, radiologically and functionally mimicking a small bowel neuroendocrine tumor (NET). The patient’s presentation, imaging, and endoscopic findings initially raised a strong suspicion of malignancy, including differential consideration for NETs due to a mid-ileal stricture with an associated mesenteric mass, avid uptake on DOTATOC PET/CT, and mesenteric lymphadenopathy. However, the histopathology of the resected specimen confirmed an actinomycotic infection, highlighting the rare and deceptive nature of this chronic suppurative disease in the gastrointestinal tract.