Pelvic actinomycosis with abundant ascites, pleural effusion, and lymphadenopathy diagnosed with endometrial biopsy and treated with medication only

Kim, Myounghwan; Ko, Ji Kyung; Lee, Chulmin

doi:10.1016/j.tjog.2013.08.010

Cited by 10 publications

(12 citation statements)

References 11 publications

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“…This result was in line with a case described of PA extended to the serosa and to the lombo-aortic lymphatic chain. After a pre-treatment diagnosis, the patient was successfully treated with antibiotics exclusively for 6 months (10 million IU/ day of penicillin G IV for 2 weeks, then amoxicillin PO 500 mg × 3/d), without recourse to surgery [34]. Previous studies have reported the need for prolonged antibiotic treatment at high doses because of the seriousness of the infection and a significant tissue fibrosis (penicillin: 2 to 6 weeks IV to continue for 6 to 12 months by oral route).…”

Section: Discussionmentioning

confidence: 99%

Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis

Carrara

Hervy

Dabi

et al. 2020

JCM

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The particularity of pelvic actinomycosis lies in the difficulty of establishing the diagnosis prior to treatment. The objective of this retrospective bicentric study was to evaluate the pertinence and efficacy of the different diagnostic tools used pre-and post-treatment in a cohort of patients with pelvic actinomycosis. The following data were collected: clinical, paraclinical, type of treatment, and the outcome and pertinence of the two diagnostic methods, bacteriological or histopathological, were evaluated. Twenty-seven women were included, with a pre-treatment diagnosis proposed for 66.7% (n = 18) of them. The diagnosis was established in 13.6% (n = 3) of cases through bacteriological samples, and in 93.8% (n = 15) of cases through histopathological samples, with endometrial biopsy positive in 100% of cases. The treatment was surgical with antibiotics for 55.6% (n = 15) of patients, medical with antibiotic therapy for 40.7% (n = 11) of patients, and surgical without antibiotics for one patient. All patients achieved recovery without recurrence, with a median follow-up of 96 days (4-4339 days). Our study suggested an excellent performance of histopathological analysis, and in particular endometrial biopsy, in the diagnosis of pelvic actinomycosis. This tool allowed early diagnosis and, in some cases, the use of antibiotic therapy alone, making it possible to avoid surgery.

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Section: Discussionmentioning

confidence: 99%

Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis

Carrara

Hervy

Dabi

et al. 2020

JCM

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“…Further evaluation by removal of IUD and pap smear collection can also support the diagnosis. Pap smear is a simple diagnostic aid of greater sensitivity than vaginal cultures, with accuracy of up to 69% [6]. Once diagnosis is confirmed, exclusive medical management with long term use of antibiotics and close follow-up is an acceptable approach which could prevent the need for extensive and risky surgical interventions in patients with pelvic actinomycosis.…”

Section: Discussionmentioning

confidence: 99%

“…The infection is characterized by suppurative and granulomatous inflammation, contiguous spread, and the formation of colonies described macroscopically as sulfur granules [2, 3, 6]. It can become pathogenic when mucosal integrity is compromised or in the presence of a foreign body, like an IUD [2].…”

Section: Introductionmentioning

confidence: 99%

“…A definitive diagnosis requires a positive anaerobic culture or histologic identification of actinomyces sulfur granules. The infection typically manifests as a unilateral tuboovarian abscess but can also present as an ovarian tumor or retroperitoneal mass that mimics a pelvic or intra-abdominal malignancy that requires extensive surgical intervention [6]. For those reasons, the diagnosis is made in most of the cases intraoperatively.…”

Section: Introductionmentioning

confidence: 99%

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Can Surgery Be Avoided? Exclusive Antibiotic Treatment for Pelvic Actinomycosis

Ruiz

Williams

Markey

et al. 2017

Case Reports in Obstetrics and Gynecology

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Pelvic actinomycosis is an uncommon, slowly progressing granulomatous infection that has been associated with the presence of intrauterine devices. Due to its unspecific clinical and radiologic findings, it can mimic pelvic or intra-abdominal malignancy leading to mutilating surgery of high morbidity. Rarely, diagnosis is made preoperatively and in most cases surgical intervention is necessary. The patient in our case is a 42-year-old female with an IUD for 15 years diagnosed with pelvic actinomycosis. Patient was uniquely diagnosed preoperatively through paracentesis and treated conservatively with prolonged antibiotic therapy and without any type of surgical intervention. Follow-up at 1 year showed almost complete radiologic resolution of the inflammatory mass, nutritional recovery, and absence of symptoms. Pelvic actinomycosis can be successfully diagnosed and treated medically without surgical interventions.

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“…Both Actinomyces and Nocardia infections are rarely associated with body cavity effusions (ie, thoracic, pericardial, peritoneal) . Typically, these effusions present secondary to associated mass lesions or pseudotumors.…”

Section: Cytopathology Of Nocardia and Actinomyces On Exfoliative Spementioning

confidence: 99%

The cytopathology of Actinomyces, Nocardia, and their mimickers

McHugh

Sturgis

Procop

et al. 2017

Diagnostic Cytopathology

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Nocardia species and Actinomyces species are 2 of the most commonly diagnosed filamentous bacteria in routine cytopathology practice. These genera share many overlapping cytomorphologic features, including their thin, beaded, branching, Gram-positive, GMS-positive filamentous structures that fragment at their peripheries into bacillary- and coccoid-appearing forms. Features that help distinguish between these 2 microorganisms include the width of their filamentous structures, the angles at which they branch, and their ability or lack thereof to retain a modified acid-fast stain. In addition to cytomorphologic overlap, overlap in clinical presentation is frequent with pulmonary and mucocutaneous presentations seen in both. Differentiating between Nocardia and Actinomyces is essential because patients with these infections require different approaches to medical management. Both antibiotic susceptibilities and the need for early surgical intervention as part of the treatment plan vary greatly among these 2 groups. This review focuses on the clinical presentation, cytomorphology and staining characteristics that can be useful in identifying and distinguishing between Nocardia and Actinomyces infections, as well as their mimickers.

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Pelvic actinomycosis with abundant ascites, pleural effusion, and lymphadenopathy diagnosed with endometrial biopsy and treated with medication only

Cited by 10 publications

References 11 publications

Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis

Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis

Can Surgery Be Avoided? Exclusive Antibiotic Treatment for Pelvic Actinomycosis

The cytopathology of Actinomyces, Nocardia, and their mimickers

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