Non-Surgical Treatment of Pelvic Actinomycosis Associated with a Pelvic Abscess: A Case Report

Abstract

Objective: Most cases of pelvic actinomycosis undergo surgical extirpation, usually by means of a hysterectomy and a bilateral salpingo-oophorectomy. We report a case of pelvic actinomycosis associated with a pelvic abscess 15 cm in diameter which was completely resolved after medical treatment alone. Case Report(s): A 47-year-old woman was transferred to our hospital due to intermittent fever and progressive abdominal distention for 2 weeks. Removal of the IUD and an endometrial curettage were pertormed by a private practician. The pathological report of the endometrium from the private practician revealed suppurative inflammation with actinomycosis. Computerized tomography showed a huge pelvic abdominal cystic mass 15 cm in diameter extending to the bilateral paracolic gutter. A staphylococcus infection was documented from the blood culture result. So, antibiotics were shifted to intravenous gentamycin (60 mg q8h) and chloramphenical (1 g/day). The fever then subsided, and the mass shrunk. The patient was discharged, and oral antibiotic therapy was maintained for 1 more month. She was free of symptoms and with no complications in the follow-up visits. A pelvic ultrasonographic examination 3 months later showed complete resolution of the pelvic mass. Conclusions(s): Pelvic actinomycosis is a rare pelvic inflammatory disease. Co-infection with other microorganisms should always be taken into consideration and may provide additional information for treatment.