Pelvic actinomycosis. A comparison of three recent cases with the literature

Pelvic actinomycosis. A comparison of three recent cases with the


A. Baird

Doncaster Royal Infirmary, Department of Obstetrics & Gynaecology,

England, UK

Introduction: I report the clinical features of three cases of pelvic

actinomycosis and compare them with Fiorino’s series, probably the most recent

authoritative review.

Report: In 1973 Henderson first reported pelvic actinomycosis with

newer generations of intrauterine device (IUD). In a systematic review, Fiorino

(1996) identified 92 cases of actinomycotic abscess associated with IUD use. The

average patient was 37 years of age, had been using an IUD for 8 years and

presented with abdominal pain, weight loss, vaginal discharge and fever.

Laboratory studies commonly revealed anaemia, leucocytosis and an elevated ESR.

Pelvic actinomycosis classically presents with tubo-ovarian abscesses formation

and is well known to mimic pelvic malignancy or inflammatory bowel disease. For

this reason, the diagnosis is usually made after extensive and unnecessary

surgery. Imaging is not always helpful here and Fiorino found the diagnosis had

only been made pre-operatively in 17% cases. If suspected at presentation it can

be successfully treated with a prolonged course of penicillin with or without

minimally invasive surgery, an important consideration in young females. Despite

its alleged rarity, 3 cases of pelvic actinomycosis presented within 3 months to

an English teaching hospital of 800 beds. Compared with Fiorino’s series they

showed many similar features, yet in no case was the diagnosis considered pre

operatively. An anaerobic bacterium of low virulence, actinomyces does not cross

intact mucous membranes, and invasive disease can take several years to develop.

Two of our three patients had undergone recent excision of cervical tissue: it

is interesting to speculate an association.

Conclusion: With the change in the January 2004 advice from the

Clinical Effectiveness Unit of the Faculty of Family Planning and Reproductive

Health Care, regarding the management of actinomyces-like organisms found on a

cervical smear in an IUD user, clinical disease may be recognised even less

frequently. The aim of this presentation is to highlight the almost classical

presentation of pelvic actinomycosis.

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