Pelvic actinomycosis: A confusing diagnosis

Mohamed Aymen Ferjaoui; Ramzi Arfaoui; Slim Khedhri; Mohamed Amine Hannechi; Kais Abdessamia; Khaoula Samaali; Wissal Fezai; Marwa Salhi; Monia Malek; Khaled Neji

doi:10.1016/j.ijscr.2021.106387

Pelvic actinomycosis: A confusing diagnosis

Int J Surg Case Rep. 2021 Sep:86:106387. doi: 10.1016/j.ijscr.2021.106387. Epub 2021 Sep 6.

Affiliations

¹ Department B of Gynecologic Surgery, Tunis Maternity Center, Tunis Medical School, El Manar University, Tunisia. Electronic address: ferjaoui16@yahoo.fr.
² Maternity Department of Tunis Military Hospital, Tunis Medical School, El Manar University, Tunisia.
³ Department B of Gynecologic Surgery, Tunis Maternity Center, Tunis Medical School, El Manar University, Tunisia.

Abstract

Introduction and importance: Actinomycosis is a rare chronic and suppurative infection caused by anerobic Gram Positive bacteria: actinomyces. Pelvic location is extremely rare, usually associated with history of IUD contraception and doesn't have specific signs. Pelvic actinomycosis diagnosis may be confused with pelvic gynecologic malignancies or abscess. We present a retrospective and descriptive study of twelve patients with pelvic actinomycosis diagnosed and managed in our department from January 2000 to December 2011.

Cases presentation: The patients' mean age was 47 years. 75% of them had a history of IUD for a mean period of 8,44 years. Pelvic pain was the most common complaint. In four cases, pre-operative clinical presumption was tubo-ovarian abscess. Gynecologic malignancies were suspected in 8 patients. Pelvic actinomycosis management was based on surgery and long-term antibiotic.

Clinical discussion: Pelvic actinomycosis is an extremely rare chronic infection, presenting 3% of human actinomycosis. Common clinical presentations include vaginal discharge, tubo-ovarian abscess and pelvic tumors mimicking gynecologic malignancies. It is difficult to diagnose. Association with IUD history was recognized. Management is based on surgery and long-term antibiotic administration.

Conclusion: Pelvic actinomycosis is an extremely rare chronic infection. This entity is difficult to diagnose. Accurate diagnosis can reduce complications and unnecessary surgeries, and can preserve fertility.

Keywords: Actinomycosis; Case series; Gynecologic surgery; IUD contraception.