Abdominal actinomycosis refers to a rare chronic suppurative infectious occurrence, caused by filamentous Gram-positive microaerophilic and anaerobic bacteria Actinomyces, that may appear as an abdominal mass and/or abscess, feasibly mimicking a malignancy 1,2. Due to its rarity and unspecific clinical evidence, the majority of cases are diagnosed after tissue specimen. We hereby report a case of a 69-year-old patient with a one week worsening abdominal pain and swelling. A large tender palpable mass in the epigastric region was noted on physical exam. An ultrasound-guided drainage followed by a surgical excision approach became both a way to confirm the diagnosis and a therapeutic tool. Diagnosis of actinomycosis was made on histopathology and microbiology. Even though the incidence of actinomycosis has decreased, the abdominal presentation has been observed with increasing frequency 3.