Pelvic Actinomycosis. Autposy Finding

Abstract

Background: Actinomycosis is a suppurative and granulomatous chronic infectious disease due to a gram positive, non-spore-forming, anaerobic bacteria, non-acid-alcohol resistant bacteria The organisms are indigenous in the oral cavity, pharynx, gastrointestinal tract, and genital tracts. There are at least 6 species that can affect the human, Actinomyces israelii is the most frequent. Methods & Materials: Autopsy is performed for alleged medical non-compliance to a 41-year-old woman with Paranoid Schizophrenia postpartum in treatment at the admission to the hospital she had normal vital parameters and standard physical examination, indirect anamnesis to parents reporting a different behavior in the last days. At necropsy, enlarged lungs are seen, with a yellowish, thick secretion. Abdomen hepatomegaly. Pelvic: left psoas with multiple abscesses. Is evidenced hypogastric plastron, involving uterus, small intestine, large intestine and bladder. To cut thick purulent brown material. Fallopian tubes and ovaries were not identified. Intrauterine contraceptive device is present. Pathologic diagnosis was: abscessed endometritis secondary to Actinomyces israelii with extension to cervix, appendages and pelvic organs with adherent plastron. Psoas abscesses with venous thrombosis. Pericarditis and lymphoplasmacytic myocarditis. Bronchopneumonia. Steatohepatitis with hemophagocytes. Disseminated intravascular coagulation. Cause of Death Organic Dysfunction Multiple-Shock Septic- abdominal-pelvic infection Endometritis by Actinomyces israelii. Results: Pelvic actinomycosis is an uncommon, opportunistic infection with a non-specific clinical course. It must be considered as a differential diagnosis in infiltrative processes suggestive of pelvic neoplasms. It presents a good evolution in the early diagnosis, with a response to beta-lactams. Schizophrenic patients show higher rates of serious infections than in the general population, since they are not aware of pain, which has an impact on morbidity and mortality, so it is suggested to perform interdisciplinary work and include in the medical controls the areas of hygiene, diet, activities, treatment of comorbid diseases and vaccines. Conclusion: The psychiatric pathology of the patient, caused that the evolution of the pathology is torpid in the absence of a clinical setting that guides tutors and doctors to the diagnosis.