Can Surgery Be Avoided? Exclusive Antibiotic Treatment for Pelvic Actinomycosis.

M P Ruiz,E M Williams,P B Morales-Ramirez,A M Johnson,C M Markey

doi:10.1155/2017/2907135

M P Ruiz, E M Williams + Show 3 more

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https://doi.org/10.1155/2017/2907135

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Abstract

Pelvic actinomycosis is an uncommon, slowly progressing granulomatous infection that has been associated with the presence of intrauterine devices. Due to its unspecific clinical and radiologic findings, it can mimic pelvic or intra-abdominal malignancy leading to mutilating surgery of high morbidity. Rarely, diagnosis is made preoperatively and in most cases surgical intervention is necessary. The patient in our case is a 42-year-old female with an IUD for 15 years diagnosed with pelvic actinomycosis. Patient was uniquely diagnosed preoperatively through paracentesis and treated conservatively with prolonged antibiotic therapy and without any type of surgical intervention. Follow-up at 1 year showed almost complete radiologic resolution of the inflammatory mass, nutritional recovery, and absence of symptoms. Pelvic actinomycosis can be successfully diagnosed and treated medically without surgical interventions.

Highlights

Pelvic actinomycosis is a rare indolent disease caused most frequently by Actinomyces israelii, an anaerobic gram positive bacillus that is part of the normal flora of the oropharynx, gastrointestinal tract, and female genital tract [1,2,3,4,5]
The infection typically manifests as a unilateral tuboovarian abscess but can present as an ovarian tumor or retroperitoneal mass that mimics a pelvic or intra-abdominal malignancy that requires extensive surgical intervention [6]
The case presented demonstrates that preoperative diagnosis of pelvic actinomycosis can be achieved through CT-guided paracentesis if there is high clinical suspicion and that conservative management with prolonged antibiotics can result in clinical and radiologic resolution

Summary

Introduction

Pelvic actinomycosis is a rare indolent disease caused most frequently by Actinomyces israelii, an anaerobic gram positive bacillus that is part of the normal flora of the oropharynx, gastrointestinal tract, and female genital tract [1,2,3,4,5]. The infection typically manifests as a unilateral tuboovarian abscess but can present as an ovarian tumor or retroperitoneal mass that mimics a pelvic or intra-abdominal malignancy that requires extensive surgical intervention [6]. The case presented demonstrates that preoperative diagnosis of pelvic actinomycosis can be achieved through CT-guided paracentesis if there is high clinical suspicion and that conservative management with prolonged antibiotics can result in clinical and radiologic resolution.

Results

Conclusion