Diagnosis and therapy of pelvic actinomycosis

Abstract

Pelvic actinomycosis is difficult to diagnose. In most cases, it is not diagnosed until after surgery. If this condition is diagnosed preoperatively, it can be treated in many cases. Three cases of actinomycosis are reported here. Three women with intrauterine devices (IUD) each presented with lower abdominal pain and pelvic mass, and elevated white blood cell count and C-reactive protein. Left salpingo-oophorectomy was performed for one the women. The pathological diagnosis was actinomycosis. For the other two women, a Gram or Papanicolaou stain of the IUD sample showed actinomycetes. They were discharged after intravenous administration of penicillin without surgery.

Intrauterine Contraceptive Device-Related Actinomycosis Infection Presenting as Ovarian Cancer with Carcinomatosis

“…The organism is unable to cross normal mucosal barriers, therefore, opportunistic infections can occur only in the context of underlying local disease. Disruption of the mucosal barrier, or a history of perforated viscus are recognized as predisposing factors [4]. Abdominal actinomycosis usually occurs following a bowel perforation, especially perforated appendicitis, or following endometriosis from the use of an IUD.…”

Rare cause of ovarian mass

“…Tetracycline, clindamycin and erythromycin can alternatively be used for patients allergic to penicillin 19. Even then, there is a role for surgical management to exclude malignancy and to treat cases who do not respond to antibiotics 8.…”

Pelvic actinomycosis: unrelated to prior intrauterine device use

“…High dose, long term antibiotic therapies are the key principles to successful resolution. [21][22][23] Protracted treatment is required for extensive disease. Duration of antibiotic therapy should be individualized based on clinical response.…”