Pelvic actinomycosis. A comparison of three recent cases with the
Doncaster Royal Infirmary, Department of Obstetrics & Gynaecology,
Introduction: I report the clinical features of three cases of pelvic
actinomycosis and compare them with Fiorino’s series, probably the most recent
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.