Pelvic Actinomycosis Mimicking Pelvic Malignancy

Abstract

Asymptomatic female genital tract colonization with Actinomyces spp is not uncommon, particularly among intrauterine device users. Pelvic actinomycosis is an extremely rare disease. The clinical picture can resemble an advanced ovarian malignancy. We report a case of pelvic actinomycosis mimicking ovarian malignancy diagnosed postoperatively. Preoperative diagnosis is possible if there is a high index of suspicion, obviating extensive surgery and preserving fertility, since long term antibiotic treatment can be completely effective. Pelvic actinomycosis should be included in the differential diagnosis of women presenting a pelvic mass, especially if there is intrauterine device use history.

Resumo

A colonização assintomática do aparelho genital feminino por Actinomyces spp não é infrequente, sobretudo em utilizadoras de dispositivo intra-uterino. A actinomicose pélvica é uma doença extremamente rara. O quadro clínico pode assemelhar-se ao de uma neoplasia maligna do ovário avançada. Relatamos um caso de actinomicose pélvica, simulando uma neoplasia maligna do ovário, com diagnóstico pós-operatório. O diagnóstico pré-operatório é possível se houver um elevado grau de suspeição, permitindo evitar cirurgias extensas e preservar a fertilidade, uma vez que o tratamento antibiótico prolongado pode ser totalmente eficaz. A actinomicose pélvica deve ser incluída no diagnóstico diferencial da mulher que apresente uma massa pélvica, sobretudo se houver história de uso de dispositivo intra-uterino.

Keywords

pelvic neoplasms - differential diagnosis - actinomycosis - intrauterine devices - anti-bacterial agents

Palavras-chave

neoplasia pélvica - diagnóstico diferencial - actinomicose - dispositivos intra-uterinos - antibióticos

• References

• 1 Wong VK, Turmezei TD, Weston VC. Actinomycosis. BMJ 2011; 343: d6099 10.1136/bmj.d6099
• 2 Ertas IE, Gungorduk K, Ozdemir A. , et al. Pelvic tuberculosis, echinococcosis, and actinomycosis: great imitators of ovarian cancer. Aust N Z J Obstet Gynaecol 2014; 54 (02) 166-171 10.1111/ajo.12191
• 3 Laios A, Terekh I, Majd HS, Pathiraja P, Manek S, Haldar K. Differentiating pelvic actinomycosis from advanced ovarian cancer: a report of two cases, management reflections and literature review. Gynecol Oncol Res Pract 2014; 1: 5 10.1186/2053-6844-1-5
• 4 Kim YJ, Youm J, Kim JH, Jee BC. Actinomyces-like organisms in cervical smears: the association with intrauterine device and pelvic inflammatory diseases. Obstet Gynecol Sci 2014; 57 (05) 393-396 10.5468/ogs.2014.57.5.393
• 5 Westhoff C. IUDs and colonization or infection with Actinomyces. Contraception 2007; 75 (6, Suppl) S48-S50 10.1016/j.contraception.2007.01.006
• 6 Persson E, Holmberg K. A longitudinal study of Actinomyces israelii in the female genital tract. Acta Obstet Gynecol Scand 1984; 63 (03) 207-216 10.3109/00016348409155498
• 7 Lippes J. Pelvic actinomycosis: a review and preliminary look at prevalence. Am J Obstet Gynecol 1999; 180 (2 Pt 1): 265-269 10.1016/S0002-9378(99)70198-5
• 8 Committee on Practice Bulletins-Gynecology, Long-Acting Reversible Contraception Work Group. Practice Bulletin No. 186: long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol 2017; 130 (05) e251-e269 10.1097/AOG.0000000000002400
• 9 Merki-Feld GS, Lebeda E, Hogg B, Keller PJ. The incidence of actinomyces-like organisms in Papanicolaou-stained smears of copper- and levonorgestrel-releasing intrauterine devices. Contraception 2000; 61 (06) 365-368 10.1016/S0010-7824(00)00121-9
• 10 García-García A, Ramírez-Durán N, Sandoval-Trujillo H, Romero-Figueroa MDS. Pelvic Actinomycosis. Can J Infect Dis Med Microbiol 2017; 2017: 9428650 10.1155/2017/9428650
• 11 Lee YC, Min D, Holcomb K, Buhl A, DiMaio T, Abulafia O. Computed tomography guided core needle biopsy diagnosis of pelvic actinomycosis. Gynecol Oncol 2000; 79 (02) 318-323 10.1006/gyno.2000.5994