Actinomycose pelvienne pseudo tumorale associée au dispositif intra-utérin: à propos de trois cas

Abstract

L'actinomycose est une maladie chronique suppurative granulomateuse d'origine infectieuse responsable d'un syndrome tumoral. La localisation pelvienne est rare et souvent associée, chez la femme, au port au long court du dispositif intra-utérin (DIU). Le diagnostic préopératoire n'est possible que dans 17% des cas. Nous rapportons trois observations, d'actinomycose pelvienne pseudo tumorale compliquées chez des femmes porteuses de DIU, qui illustrent le rôle de ce moyen de contraception dans la genèse de cette pathologie ainsi que les difficultés de prise en charge.

Pseudo tumor pelvic actinomycosis revealed by colonic obstruction with hydronephrosis: Can extensive surgery be avoided? A case report

“…The colonization rate increases with the duration of its maintenance. 2 , 5 Vasilesco et al 6 reviewed the medical records of 28 patients with abdominopelvic actinomycosis (9 men and 19 women) and the cause of actinomycosis in the studied group was an IUD device in 17 cases from which, 6 patients were admitted because they mimicked a complicated abdominopelvic malignant ovarian advanced ovarian cancer. To reduce the occurrence of this affection, it is recommended that IUDs be changed periodically, every 3–5 years.…”

“…Such a pattern may be attributed to the proteolytic enzyme produced by A israelii . 2 Moreover, some investigators suggested that patients with elevated CRP, decreased hemoglobin, increased erythrocyte sedimentation rate, and slightly increased CA125 can have renal pelvis dilation or hydronephrosis. 7 Our patient presented anemia and elevated CRP with normal tumor marker and the CT scan had objectified the local urinary and digestive impact of actinomycosis resulting in hydronephrosis and colonic occlusion.…”

“…Actinomycosis is a rare, chronic, infectious disease characterized by infiltrative, suppurative, or granulomatous inflammation, sinus fistula formation, and extensive fibrosis and caused by filamentous, gram-positive and anaerobic bacteria called the A israelii , described for the first time by Israel in 1978. 1 , 2 Actinomycosis occurs most commonly in the cervicofacial region (50%–65%), followed by the thoracic (15%–30%) and abdominopelvic (20%) regions but rarely involves the central nervous system. 3 Pelvic actinomycosis accompanied by intrauterine device (IUD) accounts for about 3% of all actinomycosis.…”