Diagnostic dilemma posed by severe pelvic actinomycosis associated with prolonged use of copper intrauterine contraceptive device

  • Subhayu Bandyopadhyay | subhayu.bandyopadhyay@nhs.net Department of Obstetrics & Gynaecology, Ninewells Hospital, Dundee, United Kingdom.
  • Sanjay Sinha Department of Obstetrics & Gynaecology, Ninewells Hospital, Dundee, United Kingdom.
  • Patrick Fan Wui Chien Department of Obstetrics & Gynaecology, Ninewells Hospital, Dundee, United Kingdom.
  • Dawn Fleming Department of pathology, Ninewells Hospital, Dundee, United Kingdom.

Abstract

Actinomycosis has been recognized to be associated with the use of intrauterine contraceptive device. We are reporting a case where a patient with severe pelvic actinomycosis presented with the clinical picture of an ovarian tumour. A 44-year-old lady attended the A&E with progressively worsening lower abdominal pain. A computerized tomography (CT) scan showed the presence of a large pelvic mass, right hydronephrosis and prominent para-aortic lymph nodes and an elevated C-reactive proteine (CRP) and white cell count (WCC). When there was no improvement with antibiotic therapy, a laparotomy was performed, where bilateral tubo-ovarian abscess and dense adhesions were found. A subtotal hysterectomy, bilateral salpingoophorectomy and small bowel resection was performed. Histopathology of the specimen confirmed the diagnosis of actinomycosis. The case highlighted the diagnostic dilemma for ascertaining the nature of the pelvic mass in this patient. Due to its invasion of surrounding tissues and the formation of masses severe infection is often confused with an ovarian neoplasm.

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Published
2011-11-25
Section
Case Reports
Keywords:
actinomycosis, pelvic mass, ovary, neoplasm, copper intrauterine contraceptive device.
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How to Cite
Bandyopadhyay, S., Sinha, S., Fan Wui Chien, P., & Fleming, D. (2011). Diagnostic dilemma posed by severe pelvic actinomycosis associated with prolonged use of copper intrauterine contraceptive device. Clinics and Practice, 1(4), e112. https://doi.org/10.4081/cp.2011.e112