Publication:

Pelvic actinomycosis: unrelated to prior intrauterine device use

Actinomycosis is a chronic, suppurative, granulomatous disease which is typically seen in the cervicofacial and thoracic regions and less commonly abdominopelvic (10-20%). It is caused by an anaerobic, filamentous gram positive bacterium which is a normal commensal of the oropharynx, gastrointestinal tract and genital tract. Pelvic actinomycosis is almost always associated with the current or prior use of an intrauterine contraceptive device. Clinical diagnosis is difficult owing to the close resemblance to an ovarian tumour. Definitive diagnosis is usually made only after histopathological correlation. Reported here is a patient with pelvic actinomycosis unrelated to the use of an intrauterine contraceptive device. This patient presented with clinical features suggestive of chronic pelvic inflammatory disease with a possible benign ovarian tumour. Operative findings were consistent with pelvic inflammatory disease. The typical histopathological features of the Splendor Hoeppli phenomenon with sulphur granules and isolation of the actinomyces organism (which is rare) revealed the diagnosis of actinomycosis of the fallopian tubes. Pelvic actinomycosis is a rare condition and seldom described in the absence of an intrauterine device. High dose, long term antibiotic therapy is the key to successful resolution with surgery reserved for refractory cases. This patient showed good clinical and radiological response.