Abdominal actinomycosis associated with intrauterine device: CT features

Abstract

Abdominal actinomycosis is a severe and progressive peritoneal infection, due to an anerobic gram-positive bacterium, Actinomyces israelii. The presence of a long-standing intrauterine device (IUD) is a well-known risk factor in young women. We report two cases of pelviperitoneal actinomycosis appearing in two young women with acute low abdominal pain. Abdominal CT demonstrated multiple solid or encapsulated peritoneal masses with marked contrast enhancement and infiltration of the adjacent mesenteric fat. Laparoscopy confirmed the presence of intraperitoneal abscesses which contained Actinomyces israelii. High doses of amoxicillin and clavulanic acid (Augmentine) were given and following CT scan after 2 and 6 weeks showed a slow, but complete, resolution of the lesions. Although the radiologic presentation of actinomycosis is nonspecific, the diagnosis should be raised in the presence of pseudotumoral mesenteric infiltration, particularly in young women with an IUD. Abdominal CT is a useful method for diagnosis and for follow-up.

Abdominal actinomycosis with multiple myeloma: A case report

“…Infections progress locally rather than hematogenously (5). The most frequently observed clinical presentations are oral-cervico-facial, thoracic, abdominal and pelvic disease but disseminated and central nervous system infections may be seen (1,2,4,6,7). Primary hepatic, splenic, gastric, pancreatic, biliary tract or intestinal infections are rare, but these forms may be seen in patients with underlying immune-suppressive disorders including leukemia, auto-immune disease, alcoholism and diabetes mellitus (11,12).…”

“…Pelvic actinomycosis may be seen in those using an intra-uterine device, which can often cause abdomino-pelvic actinomycosis (4,6,14–17). Other risk factors include an horseshoe kidney, reno-duodenal fistula and urachal remnants (18–21).…”

“…Dental procedures, surgery, endoscopic interventions and trauma may result in impairment to the mucosal barriers (5). Poor oral hygiene, immune-suppression and long-term intra-uterine devices are the predisposing conditions for this infection (6,7). Actinomycosis has been reported in patients with lymphoma, leukemia, renal failure and renal transplantation, and long-term steroid users due to immune-suppression (8,9).…”

Large Bowel Obstruction in a Young Woman Simulating a Malignant Neoplasm: A Case Report ofActinomycesInfection

“…CT is the most useful imaging study as it reveals the extent of the disease. Most common CT features at abdominopelvic [6] region include bowel wall thickening and solid mass with possible cystic elements. Despite advanced imaging and diagnostics, most patients undergo operative procedure.…”

Abdominal Actinomycosis Associated with a Sigmoid Colon Perforation in a Patient with a Ventriculoperitoneal Shunt

“…It is usually diagnosed by histological demonstration of sulfur granules in a postoperative surgical specimen and with culture for Actinomyces israelii 2,3. Although intrauterine device (IUD)-related abdominal actinomycosis has been frequently reported,4-6 abdominal actinomycosis by bowel perforation in the patient with a ventriculoperitoneal shunt (VP shunt) has not been previously reported. Here, we report the case of abdominal actinomycosis causing hydronephrosis associated with spontaneous bowel perforation, secondary to the VP shunt.…”