Abstract
Actinomycosis is a chronic or subacute bacterial infection characterized by large abscess formation, caused mainly by the gram-positive non-acid-fast, anaerobic, or microaerophilic/capnophilic, obligate parasites bacteria from the Actinomyces genus. Although pelvic inflammatory disease is an entity associated with the longstanding use of intrauterine devices (IUDs), actinomycosis is not one of the most frequent infections associated with IUDs. We present the case of a 43-year-old female patient who was referred to the emergency facility because of a 20-day history of abdominal pain with signs of peritoneal irritation. Imaging exams revealed collections confined to the pelvis, plus the presence of an IUD and evidence of sepsis, which was consistent with diffuse peritonitis.An exploratory laparotomy was undertaken, and a ruptured left tubal abscess was found along with peritonitis, and a huge amount of purulent secretion in the pelvis and abdominal cavity. Extensive lavage of the cavities with saline, a left salpingo-oophorectomy, and drainage of the cavities were performed. The histopathological examination of the surgical specimen revealed an acute salpingitis with abscesses containing sulfur granules. Therefore, the diagnosis of abdominal and pelvic actinomycosis was made. The postoperative outcome was troublesome and complicated with a colocutaneous fistula, which drained through the surgical wound. A second surgical approach was needed, requiring another extensive lavage and drainage of the recto-uterine pouch, plus the performance of a colostomy. Broad-spectrum antibiotics added to ampicillin were the first antimicrobial regimen followed by 4 weeks of amoxicillin during the outpatient follow-up. The patient satisfactorily recovered and is already scheduled for the intestinal transit reconstitution.
Highlights
Actinomycosis is a chronic or subacute bacterial infection characterized by large abscess formation, caused mainly by the gram-positive non-acid-fast, anaerobic, or microaerophilic/capnophilic, obligate parasites bacteria from the Actinomyces genus
Ampicillin was added to the antibiotic regimen and the patient’s clinical condition improved substantially
Actinomycosis is a rare, subacute, or chronic suppurative disease, which, in more than 98% of the cases, is caused by the Gram-positive non-acid-fast, anaerobic or microaerophilic/capnophilic, filamentous, obligate bacteria of the Actinomyces species. The incidence of this infection is 1:300,000.1 other associated bacterial genera may be involved in the etiology of this entity, such as Propionibacterium and Bifidobacterium
Summary
A 43-year-old female inmate was referred to the emergency facility complaining of diffuse abdominal pain for the last 20 days that had recently worsened. The physical examination revealed an ill‐looking patient, dehydrated, tachypneic (30 respiratory movements per minute), and tachycardic a Faculty of Medicine - Universidade de São Paulo, São Paulo/SP – Brazil. The abdominal and pelvic computed tomography (CT) showed the presence of at least three poorly defined collections in the pelvis with densification of the fat adnexal planes, besides the dilation and thickening of some small bowel loops, and the presence of an IUD (Figure 1). The lesion was sutured and an extensive peritoneal cavity lavage with saline and a loop sigmoidostomy were performed. Ampicillin was added to the antibiotic regimen and the patient’s clinical condition improved substantially She was discharged with the prescription of amoxicillin for the 4 months. She is attending our outpatient clinic with the transit reconstruction scheduled
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