Abdominopelvic Actinomycosis Associated With an Intrauterine Device and Presenting With a Rectal Mass and Hydronephrosis: A Troublesome Condition for the Clinician

Abstract

Actinomycosis is an uncommon, chronic, granulomatous disease that can be mistaken for a malignant tumor. Abdominopelvic actinomycosis constitutes about 20% of all actinomycosis cases and may mimic malignancy, tuberculosis, or other abdominopelvic inflammatory diseases. This condition is more prevalent in women who use an intrauterine device. We treated a 44-year-old woman who presented with vaginal discharge, right flank pain, dysuria, and difficulty with defecation. She had anorexia and weight loss (8 kg) during the previous 2 months and had a history of intrauterine device use for 12 years. Clinical, radiologic, and endoscopic examinations revealed a rectal mass and right hydronephrosis. Rectal biopsy showed nonspecific colitis. Laparotomy showed a mass that was invading and obstructing the pelvic orifice. Surgery included total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, low anterior resection, and Hartmann colostomy. Histopathologic evaluation of surgical specimens showed actinomycosis originating from the tubo-ovarian structures and invading the rectal wall. The patient was placed on penicillin for 6 months, and then had closure of the colostomy with no complication.

Actinomycosis of the cervix mimicking stage II cervical cancer

“…Actinomyces can be identified on routine vaginal examination in 10% of asymptomatic intrauterine contraceptive device (IUD) users, and 25% of IUD users have associated symptoms. [ 9 ] The incidental finding of Actinomyces -like organisms on a Pap smear does not require antimicrobial treatment or IUD removal. [ 6 ] The Pap smear received showed inflammatory cells but upon revision, we could identify the actinomycosis colonies in the slides.…”

Abdominal and pelvic actinomycosis due to longstanding intrauterine device: a slow and devastating infection

“… 2 Pelvic actinomycosis is usually associated with the longstanding use of IUDs, 6 - 8 and frequently represents a challenging diagnostic task because of the similarity with tuberculosis, malignancy, or other abdominopelvic inflammatory disease. 1 , 6 , 7 …”

Actinomyces-induced inflammatory myofibroblastic tumor of the colon: A rare cause of an abdominal mass

“…The management of abdominopelvic actinomycosis is dependent on both the extent of the disease and the condition of the patient [9] . Surgical removal of the tumoral lesion with resection or drainage, supplemented with long-term antibiotic therapy is recommended, [9,10] such as with parenteral penicillin G [2,9] followed by peroral penicillin V or amoxicillin for up to 12 months [2,9,10] . Tetracycline, erythromycin, clindamycin can be given in those with penicillin allergy [2] .…”