Isolated ovarian actinomycosis – a diagnosis often underlooked

C Vijaya,A Shetty,V Geethamani

doi:10.4038/sljog.v35i1.6006

C Vijaya, A Shetty + Show 1 more

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https://doi.org/10.4038/sljog.v35i1.6006

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Abstract

Pelvic Actinomycosis is rare, and isolated ovarian actinomycosis even rarer. We present an interesting case of a 39 year old lady, who was extensively worked up, following a clinical suspicion of ovarian cancer. The postoperative diagnosis was ovarian actinomycosis. In majority of cases, including ours, the indolent clinical course, together with the malignant tumour like appearance at imaging was misleading, and a final diagnosis of actinomycosis was made only after the histological examination of the specimen. Although ovarian actinomycosis is often related to the use of intra-uterine device (IUD), the index case did not have any history of using IUD, also there was no evidence of actimomycosis elsewhere, including abdomen. We present this case, not only for its diagnostic dilemma and rarity, but also to highlight the fact that a high suspicion for actinomycotic infection can spare the patient from radical and excessive surgical intervention. DOI: http://dx.doi.org/10.4038/sljog.v35i1.6006 Sri Lanka Journal of Obstetrics and Gynaecology 2013; 35 : 37-39

Highlights

Actinomycosis is a suppurative, chronic granulomatous disease, caused by any of several anaerobic organisms from the genus Actinomyces
We present a case of a 39 year old lady, in the absence of history of intrauterine device (IUD) usage, presenting with abdominal pain, which was worked up keeping in mind a diagnosis of ovarian malignancy
Pelvic actinomycosis is rare and ovarian actinomycosis is rarer as its structure is resistant to surrounding inflammatory disease

Summary

Introduction

Actinomycosis is a suppurative, chronic granulomatous disease, caused by any of several anaerobic organisms from the genus Actinomyces. Pelvic pain and painful micturition for one week duration She was not married and did not give any history of using an IUD. CT abdomen and pelvis showing the left adnexal mass with an of intrauterine device (IUD) is considered a risk factor in ovarian actinoattached cyst (arrow) mycosis. We present a case of a 39 year old lady, in the absence of history of IUD usage, presenting with abdominal pain, which was worked up keeping in mind a diagnosis of ovarian malignancy. Right adnexal mass measured 7 × 4 × 3 cm[3] and appeared nodular on gross examination. Microscopy of the adnexal mass showed the foci of matted filamentous organisms surrounded by the amorphous eosinophilic material (Figure 2). Section from the cyst showed a haemorrhagic corpus leuteum. Post-operatively the patient was put on IV penicillin for a week, was discharged and was on oral penicillin for 2 weeks. 3 months post-operatively the patient came for a follow up, which was uneventful

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