Vaginal Actinomycosis in a Female without a History of Intrauterine Contraception: A Case Report

Abstract

<h3>Study Objective</h3> describe a relationship between actinomycosis and persistent foreign bodies in the female genital tract; emphasize the importance of pre-therapeutic biopsy in genital tract disease. <h3>Design</h3> Actinomycoses are opportunistic bacteria that can cause invasive, suppurative infections when mucosal barriers are compromised. Most cases are seen in patients with long-term use of intrauterine devices (IUDs). Infections are slow-growing and produce non-specific symptomatology, making initial misdiagnosis of malignancy or other pathologies common. This may lead to avoidable surgery, as most actinomycosis resolves with antibiotics alone. We present a case of isolated vaginal actinomycosis in a 66-year-old female without a history of IUD use, presenting with post-menopausal bleeding. She had a remote history of colpoperineorrhaphy with inorganic mesh placement, and a total abdominal hysterectomy and bilateral salpingectomy. Preoperative biopsy guided a less invasive surgical approach than that considered for malignancy. <h3>Setting</h3> The patient presented at her outpatient gynecologist. Biopsy revealed actinomycosis. Surgical excision occurred via a posterior approach with the patient in lithotomy position. <h3>Patients or Participants</h3> 66-year-old post-menopausal female without a history of IUD use, presenting with post-menopausal bleeding. <h3>Interventions</h3> The rectovaginal septum was dissected and 3.25cm x 1.5cm of tissue/mesh were excised. The healthy vaginal epithelium was reapproximated. The patient was treated with 6 weeks of ceftriaxone followed by 30 days of amoxicillin-clavulanate. <h3>Measurements and Main Results</h3> Histopathological report demonstrated acute and chronic inflammation, granulation tissue and no evidence of malignancy. The patient recovered well after surgery. <h3>Conclusion</h3> This case is notable for actinomycosis isolated to the vagina and in a female without concomitant IUD-use, suggesting a relationship between actinomycosis and <i>any</i> foreign body in the lower female genital tract. Actinomycosis should be considered for any slow-growing mass with foreign body presence. Preoperative biopsy or, at a minimum, intraoperative frozen section should be obtained to prevent unnecessary surgery.