Abstract
Actinomycosis has been recognized to be associated with the use of intrauterine contraceptive device. We are reporting a case where a patient with severe pelvic actinomycosis presented with the clinical picture of an ovarian tumour. A 44-year-old lady attended the A&E with progressively worsening lower abdominal pain. A computerized tomography (CT) scan showed the presence of a large pelvic mass, right hydronephrosis and prominent para-aortic lymph nodes and an elevated C-reactive proteine (CRP) and white cell count (WCC). When there was no improvement with antibiotic therapy, a laparotomy was performed, where bilateral tubo-ovarian abscess and dense adhesions were found. A subtotal hysterectomy, bilateral salpingoophorectomy and small bowel resection was performed. Histopathology of the specimen confirmed the diagnosis of actinomycosis. The case highlighted the diagnostic dilemma for ascertaining the nature of the pelvic mass in this patient. Due to its invasion of surrounding tissues and the formation of masses severe infection is often confused with an ovarian neoplasm.
Highlights
Actinomycosis is caused by the anaerobic bacterium Actinomyces israelii
We report a patient who presented with the clinical picture of an ovarian tumour but was later diagnosed with pelvic actinomycosis
Actinomycosis is caused by gram positive bacteria which form fungus like branched networks of hyphae
Summary
Actinomycosis is caused by the anaerobic bacterium Actinomyces israelii. Infection and asymptomatic cervicovaginal colonization with Actinomyces have been recognized as potential consequences of the use of intrauterine contraceptive device (IUCD).[1,2,3] The reported prevalence of infection with Actinomyces israelii in the IUCD user ranges from 1.6% to 11.6 %.4. Symptomatic infection may occur, with the potential for extensive morbidity and even death.[2] We report a patient who presented with the clinical picture of an ovarian tumour but was later diagnosed with pelvic actinomycosis. Because of the current resurgence in the prescribing and use of IUCD,[5] we feel that it is important to highlight this case
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