Abstract
Introduction: Intrauterine contraceptive devices generally carry a low risk of complications. Infection, possibly due to damage caused upon insertion, can occur and actinomycetaceae are the most likely cause of pelvic actinomycosis. Case report: A 41-year-old female presented with a two-month history of raised temperature, weight loss and abdominal tenderness. Contrast tomography imaging indicated pyometria and pelvic actinomycosis-like abscess linked to intrauterine contraceptive device use. Full microbiological reporting, including anaerobic cultures and 16S PCR, identified the bacterium Propionibacterium propionicum. A six-month course of amoxicillin resolved the infection and the patient made a full recovery. Conclusion: Increased IUCD-related actinomycosis awareness and improved diagnostics may increase detection of P. propionicum, a pathogen rarely reported on to date.
Highlights
Intrauterine contraceptive devices generally carry a low risk of complications.Infection, possibly due to damage caused upon insertion, can occur and actinomycetaceae are the most likely cause of pelvic actinomycosis.Case Report: A 41-year-old female presented with a two-month history of raised temperature, weight loss and abdominal tenderness
Some case reports and case series have described actinomycosis, and it has been suggested that the incidence of this complication is higher than generally thought [3, 4]
Only a few case report publications have reported such instances with only one showing positive culture of the anaerobe P. propionicum which normally resides in sweat glands and on the skin [5,6,7]
Summary
The use of Intrauterine contraceptive devices (IUCD) does carry a risk of infection; actinomycetaceae are the most likely cause of pelvic actinomycosis [1,2,3]. We report a case of pyometra and pelvic actinomycosis-like abscess, linked to an in situ intrauterine contraceptive device. Ultrasound of the abdomen and pelvis showed a normalsized anteverted uterus with an IUCD in situ within the endometrial cavity. It confirmed earlier CT scan findings regarding bilateral complex adnexal cysts; measurements were 70x63x61 mm (right) and 63x48x54 mm (left). The patient was started on a regime of intravenous amoxicillin (1 gram tid for 6 weeks) followed by oral amoxicillin 1 gram tid for six months. Further notable improvement was noted at sixth-month follow-up visit via computed tomography scan (Figures 4 and 5)
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