Abdominopelvic actinomycosis mimicking disseminated peritoneal carcinomatosis

Abstract

We present a case of a 38-year-old woman who presented with symptoms suggestive of intra-abdominal or pelvic malignancy: marked weight loss, abdominal pain, altered bowel habit, anorexia and fatigue. The findings of multiple peritoneal deposits, adnexal and presacral masses on CT imaging and appearances on diagnostic laparotomy also suggested malignancy. However, the histological analysis was inconsistent with malignancy and revealed an infection withActinomyces israelii. The patient started a course of intravenous antibiotics and complete resolution is expected. An intrauterine contraceptive device was identified as the likely source of the infection.

A Case Report of Pelvic Actinomycosis and a Literature Review

“…Abdominal actinomycosis usually originates after diaphragm perforation, which is more common in males than females [ 6 ]. In recent years, the incidence of female pelvic actinomycosis has been rising, which is mainly related to the increased placement of IUDs [ 7 ]. Even after the removal of an IUD, some patients may be affected because of various degrees of damage to the endometrium caused by stimulation from the IUD, intrauterine flora disorders, and insufficient blood supply to the endometrium [ 8 ].…”

“…A large dose and long course of treatment are needed to prevent recurrence, and the possibility of IUD implantation should be considered in gynecological diseases. Studies have shown that actinomycetes are sensitive to a variety of antibiotics, and sulfonamides, erythromycin, doxycycline, tetracycline, and other drugs can be used when there is penicillin allergy or antibiotic resistance [ 5 – 7 ]. In addition, it has been reported that levofloxacin also has a therapeutic effect on actinomycosis [ 9 ].…”

Abdominopelvic Actinomycosis Mimicking Peritoneal Carcinomatosis: A Case Report

“…Additionally, individuals with mucous membrane injury and immune deficiency are predisposed to actinomycosis. A. israelii (the main causative agent) becomes saprophytic under anaerobic conditions and penetrates the injured mucosa [ 6 ]. Invasion of host tissue precipitates the inflammatory response which can result in the formation of multiloculated abscesses and pseudotumors.…”

“…For example, actinomycosis of the gastrointestinal (GI) tract or the parietal peritoneum is often indistinguishable from GI tract carcinoma or carcinomatosis. Notably, actinomycosis involving multiple sites of the parietal peritoneum is rare [ 6 ]. Although CT is a useful diagnostic modality for visualization of actinomycotic lesions, it cannot conclusively establish the diagnosis [ 8 ].…”

Pelvic actinomycosis: unrelated to prior intrauterine device use

“…2 Clinical diagnosis is difficult owing to the close resemblance to an ovarian tumour. 3 Definitive diagnosis is usually made only after histopathological correlation. 4 Reported here is a patient with pelvic actinomycosis unrelated to the use of an intrauterine contraceptive device.…”