Pseudotumoral pelvic actinomycosis in a woman who had been using an IUD for 15 years
Ben Nasr, R.; Ben Othman, M.; Cammoun, M.
La Tunisie Medicale 67(8-9): 563-565
1989
ISSN/ISBN: 0041-4131 PMID: 2799985 Document Number: 337381
A 56-year-old woman was referred to a hospital in Tunis for a tumor of the right ovary. The patient had had 11 term pregnancies and had been using an IUD with no medical supervision for 15 years. She complained of recent constipation and weight loss. The uterus was of normal size but of hard consistency and fixed to the sacrum. A cervical smear was normal. The patient was found to be anemic and the sedimentation rate was accelerated. A diagnosis of probably malignant tumor of the right ovary was made and a hysterectomy with bilateral ovarectomy was performed after laparotomy. The patient left the hospital after receiving a prescription for ampicillin and was lost to follow-up. Histological examination showed the mass to be comprised of inflammatory fibrous and granulomatous tissue with numerous abscesses of a filamentous, strongly eosinophilic character suggesting actinomycosis. Pelvic actinomycosis is a rare chronic infection caused by a gram positive anaerobic bacteria, Actinomyces Israeli. The clinical signs usually include anemia, weight loss, and pelvic mass. Clinical diagnosis is difficult, and diagnosis is usually based on histological and bacteriologic examination. Observation of the symptoms in association with IUD use suggests actinomycosis. The treatment of choice combines surgery with antibiotic therapy for 2 months. Cervical smears should be regularly scheduled for IUD users not only to screen for prenoplastic and neoplastic lesions but to indicate actinomycosis at an early stage when treatment will allow serious complications to be avoided.