Actinomycosis Simulating Malignancy on CT: A Case of A Long-Forgotten IUD

Abstract

Actinomyces Israelii is known to be commensal, particularly in the gums and tonsils, sometimes in the vagina. The diagnosis of actinomycosis is challenging owing to nonspecific clinical findings. First instance imaging often resembles inflammatory and infective pathologies like Crohn’s or intestinal tuberculosis, and in this case, abdominal malignancies [1]. Actinomycosis infectionsare complicated by their tendency to extend into surrounding structures and develop fistulae [2]. Our case report specifically looks at a fit-and-well female patient who had been referred under a suspected gastrointestinal cancer pathway after a recent change in bowel habit for CT imaging which was subsequently thought to be disseminative malignant growths. Our 56-year-old lady had an indurating mass in her abdomen draining pus which prompted her GP to discuss this case with the surgeons. On further MRI imaging and lab cultures, it was revealed that the sinister mass is found to be an Actinomyces Israelii colonised long-forgotten IUD placed 12 years ago. The unfortunate patient suffered widespread abdominal involvement which required extensive surgery involving major bowel resection, salpingo-oopherectomy, bilateral ureteric stents for hydronephrosis and a partial cystectomy.