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Actinomycosis is a chronic inflammatory condition caused by Actinomyces israeli, a gram positive anaerobic bacterium. It can
have a variety of clinical manifestations and can mimic a malignancy. We present one such case of urachal actinomycosis that
mimicked a tumor. A 28-year-old man presented with abdominal pain of 20 days duration. Per abdominal palpation revealed
a firm mass with ill-defined borders in the suprapubic region. Computed tomography and magnetic resonance imaging scans
of the pelvis showed an irregular lesion in the urinary bladder extending to the umbilicus, giving the impression of urachal
remnants with inflammation. Peroperatively, an irregular, hard mass measuring 6 x 5 cm, involving the anterior and posterior
bladder walls, the appendix, the terminal ileum and sigmoid colon, was seen, which was suspicious for a malignancy. Frozen
sections from the mass showed extensive inflammation and a florid fibroblastic proliferation, giving the impression of an
inflammatory pseudotumor. The tissue was extensively sampled for paraffin sections and only one of them revealed a colony
of Gram, PAS and GMS- positive organisms, conclusive for Actinomycosis. It is important to be aware of this uncommon, yet
significant, presentation of a common infectious disease in order to avoid misdiagnosis and over-treatment as a malignancy.