Actinomyces Associated With Persistent Vaginal Granulation Tissue

Clifford Y Wai,David L Hemsell,Joe S Chang,Mikio A Nihira,Peter G Drewes,Momin T Siddiqui

doi:10.1155/2005/252691

Abstract

Background:We report a case of symptomatic actinomycosis associated with vaginal suture erosion and granulation tissue refractory to conservative management, in an outpatient setting.Case:Three months after total vaginal hysterectomy and uterosacral ligament vaginal vault suspension, a woman complained of painless, intermittent vaginal discharge and spotting. Despite cauterization of granulation tissue, vaginal spotting persisted for another month. On re-examination, braided polyester suture that was found underlying the granulation tissue was removed. Recurrent symptoms, together with a biopsy revealing actinomycetes, prompted a trial of oral penicillin VK. With persistent symptoms and discomfort during attempts in the outpatient clinic, the woman eventually required suture removal in the operating room. Her symptoms subsequently resolved without recurrence, and no further antibiotic treatment was required.Conclusions:Actinomyces may be associated with persistent granulation tissue and vault suspension suture material. In rare circumstances, when tissue debridement and suture removal in the clinic is unsatisfactory, surgical intervention in the operating room may be necessary. Ten days of antibiotic therapy alone did not eradicate the granulation tissue, and symptoms resolved only after complete removal of the underlying permanent suture.

Highlights

Actinomyces is a Gram-positive anaerobic organism that can be found in association with a pelvic foreign body, such as an intrauterine device (IUD) [1]
We describe a case of superficially symptomatic actinomycosis presenting as granulation tissue associated with vaginal suture erosion, that was refractory to conservative short-term management
A number of reports of actinomyces associated with the intrauterine device have been published, with the first reported case appearing in 1973 [8]

Summary

Introduction

Actinomyces is a Gram-positive anaerobic organism that can be found in association with a pelvic foreign body, such as an intrauterine device (IUD) [1]. Separate isolation of this organism in an asymptomatic individual without a foreign body has traditionally been considered of no pathophysiologic consequence. Some have reported success with short-term antibiotic treatment. Isolation of actinomyces and suture erosion following vaginal vault suspension has not been reported previously in the English-language literature. We describe a case of superficially symptomatic actinomycosis presenting as granulation tissue associated with vaginal suture erosion, that was refractory to conservative short-term management

Case report

Discussion