Extensive actinomycosis associated with an intrauterine contraceptive device

Abstract

A case of thoracic and abdominal actinomycosis as a complication of pelvic actinomycosis associated with an IUD is described. The patient 1st noted a yellowish vaginal discharge and pelvic pain. A hysterogram showed a Dalkon Shield to be intrauterine. 3 weeks after the IUD was removed chest pain fever weight loss and abdominal pain were present. Examination revealed a pelvic mass. Chest X-ray showed fluid on the left side. Kanamycin and penicillin G were given iv. Thoracentesis removed 500 ml of thick yellow fluid. Cultures of this fluid and blood cultures were negative. Chloromycetin was given. A gallium-67 scan revealed abnormal foci in the pelvis thorax and subdiaphragmatic areas. Laparotomy revealed bilateral tuboovarian abscesses. Abdominal hysterectomy and salpingo-oophorectomy were performed. Pelvic and subdiaphragmatic abscesses were drained. Sulfur granules were noted in Fallopian tube sections. Actinomyces organisms were found in centrifuged pleural fluid. The organism (Actinomyces israeli) forms yellow particles called sulfur granules. Finding them was an aid in diagnosis. Invasion is facilitated if local tissue damage with or without a foreign body is present. This case probably represents an ascending-route infection. Treatment consists of removal of devitalized tissue draining abscesses and antibiotic therapy. Therapy may require several months. Penicillin is usually used; tetracycline is also effective.