Disseminated Pelvic Actinomycosis Caused by Actinomyces Naeslundii.

Jana Kulichová,Jiří Beneš,Olga Džupová

doi:10.3390/antibiotics9110748

Jana Kulichová, Jiří Beneš + Show 1 more

Open Access

https://doi.org/10.3390/antibiotics9110748

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Abstract

Actinomycosis is a chronic bacterial infection characterized by continuous local spread, irrespective of anatomical barriers, and granulomatous suppurative inflammation. Due to its expansive local growth, it can simulate a malignant tumour. Subsequent hematogenous dissemination to distant organs can mimic metastases and further increase suspicion for malignancy. A case of severe disseminated pelvic actinomycosis associated with intrauterine device is described here. The patient presented with a pelvic mass mimicking a tumour, bilateral ureteral obstruction, ascites, multinodular involvement of the liver, lungs and spleen, inferior vena cava thrombosis and extreme cachexia. Actinomycosis was diagnosed by liver biopsy and confirmed by culture of Actinomyces naeslundii from extracted intrauterine contraceptive device (IUD). Prolonged treatment with aminopenicillin and surgery resulted in recovery with moderate sequelae.

Highlights

Actinomycosis is a disease with characteristic features, including a slow growth of a solid mass arising from local massive fibroproduction, spread across tissues regardless of natural barriers resembling a malignant tumour, formation of abscesses and fistulas, and growth of bacteria in the colonies surrounded by granulomatous inflammation, macroscopically described as sulphur granules [1]
We describe a female patient with disseminated actinomycosis secondary to intrauterine contraceptive device (IUD)
Pelvic actinomycosis is associated with the use of an IUD in the majority of reported cases [5,15,16,17,18,19]

Summary

Introduction

Actinomycosis is a disease with characteristic features, including a slow growth of a solid mass arising from local massive fibroproduction, spread across tissues regardless of natural barriers resembling a malignant tumour, formation of abscesses and fistulas, and growth of bacteria in the colonies surrounded by granulomatous inflammation, macroscopically described as sulphur granules [1]. Many authors do not recognize the pelvic form as a separate unit and report on abdominopelvic actinomycosis [2,3,4,5,6] This approach is based on the idea that intestinal actinomycosis and uterine actinomycosis have different pathogeneses, the clinical course is similar and differentiation in the advanced stage can be difficult. It was considered a saprophyte of the human mouth and occasional agent of periodontal disease and dental root caries [10,11] This role is assigned to the new species Actinomyces oris that was separated from A. naeslundii in 2009 [12]. The case indicates the ability of this infection to progress slowly with only general non-specific symptoms to an advanced stage imitating a malignant metastatic gynaecological tumour

Case Presentation

Histopathology

Discussion