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

Evelyn Sue Nakahira, Linda Ferreira Maximiano, Fabiana Roberto Lima, Edson Yassushi Ussami

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Actinomycosis is a chronic or subacute bacterial infection characterized by large abscess formation, caused mainly by the gram-positive non-acid-fast, anaerobic, or microaerophilic/capnophilic, obligate parasites bacteria from the Actinomyces genus. Although pelvic inflammatory disease is an entity associated with the longstanding use of intrauterine devices (IUDs), actinomycosis is not one of the most frequent infections associated with IUDs. We present the case of a 43-year-old female patient who was referred to the emergency facility because of a 20-day history of abdominal pain with signs of peritoneal irritation. Imaging exams revealed collections confined to the pelvis, plus the presence of an IUD and evidence of sepsis, which was consistent with diffuse peritonitis. An exploratory laparotomy was undertaken, and a ruptured left tubal abscess was found along with peritonitis, and a huge amount of purulent secretion in the pelvis and abdominal cavity. Extensive lavage of the cavities with saline, a left salpingo-oophorectomy, and drainage of the cavities were performed. The histopathological examination of the surgical specimen revealed an acute salpingitis with abscesses containing sulfur granules. Therefore, the diagnosis of abdominal and pelvic actinomycosis was made. The postoperative outcome was troublesome and complicated with a colocutaneous fistula, which drained through the surgical wound. A second surgical approach was needed, requiring another extensive lavage and drainage of the recto-uterine pouch, plus the performance of a colostomy. Broad-spectrum antibiotics added to ampicillin were the first antimicrobial regimen followed by 4 weeks of amoxicillin during the outpatient follow-up. The patient satisfactorily recovered and is already scheduled for the intestinal transit reconstitution.


Actinomycosis; Salpingitis; Oophoritis; Abscess, Intestinal Perforation; Fistula


1. Montori G, Allegri A, Merigo G, et al. Intra-abdominal actinomycosis, the great mime: case report and literature review. Emerg Med Heal Care. 2015;3(1):2.

2. Boyanova L, Kolarov R, Mateva L, Markovska R, Mitov I. Actinomycosis: a frequently forgotten disease. Future Microbiol. 2015;10(4):613-28. PMid:25865197.

3. Baraket O, Itaimi A, Triki W, et al. Difficultés diagnostiques et thérapeutiques de l’actinomycose abdominale : à propos d’une observation chez une patiente tunisienne. Bull Soc Pathol Exot. 2016;109(2):84-6. PMid:27100860.

4. Israel J. Neue Beobachtungen auf dem Gebiete der Mykosen des Menschen. Arch Pathol Anat Physiol Klin Med. 1878;74(1):15-53.

5. Cone LA, Leung MM, Hirschberg J. Actinomyces odontolyticus bacteriemia. Emerg Infect Dis. 2003;9(12):1629-32. PMid:14720410.

6. Mbarki C, Ben Abdelaziz A, Sahnoun R, et al. Actinomycose pelvienne: aspects diagnostiques et thérapeutiques. Gynecol Obstet Fertil. 2016;44(3):168-74. PMid:26857044.

7. Yilmaz M, Akbulut S, Samdanci ET, Yilmaz S. Abdominopelvic actinomycosis associated with an intrauterine device and presenting with a rectal mass and hydronephrosis: a troublesome condition for the clinicians. Int Surg. 2012;97(3):254-9. PMid:23113856.

8. Evans DT. Actinomyces israelii in the female genital tract: a review. Genitourin Med. 1993;69(1):54-9. PMid:8444484.

9. Wagenlehner FM, Mohren B, Naber KG, Männl HF. Abdominal actinomycosis. Clin Microbiol Infect. 2003;9(8):881-5. PMid:14616714.

10. Desteli GA, Gürsu T, Bircan HY, Kizilkiliç E, Demiralay E, Timurkaynak F. Thrombocytosis and small bowel perforation: Unusual presentation of abdominopelvic actinomycosis. J Infect Dev Ctries. 2013;7(12):1012-5. PMid:24334952.

11. Lee IJ, HaHK, ParkCM, et al. Abdominopelvic actinomycosis involving the gastrointestinal tract: CT features. Radiology. 2001;220(1):76-80. PMid:11425976.

12. Onal ED, Altinbas A, Onal IK, et al. Successful outpatient manegement of pelvic actinomycosis by ceftriaxone: a report of three cases. Braz J Infect Dis. 2009;13(5):391-3. PMid:20428643.

13. Koneman EW, Allen SD, Janda WM. Schreckenberger. In: Winn WC Jr, editors. Color atlas and textbook of diagnostic microbiology. 5th ed. Philadelphia: Lippincott-Raven; 1997.

14. Valour F, Sénéchal A, Dupieux C, et al. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist. 2014;7:183-97. PMid:25045274.

15. Bonnefond S, Catroux M, Melenotte C, et al. Clinical features of actinomycosis: a retrospective, multicenter study of 28 cases of miscellaneous presentations. Medicine (Baltimore). 2016;95(24):e3923. PMid:27311002.

16. Valour F, Sénéchal A, Dupieux C, et al. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist. 2014;7:183-97. PMid:25045274.

17. Ferrari TCA, Couto CA, Murta-Oliveira C, Conceição SA, Silva RG. Actinomycosis of the colon: a rare form of presentation. Scand J Gastroenterol. 2000;35(1):108-9. PMid:10672844.

18. McDermott M, Tanner A, Hourihane D. Abdominal actinomycosis following small intestinal perforation in an umbilical hernia: a case report and review of literature. Ir J Med Sci. 1993;162(5):182-3. PMid:8335456.

19. Fesołowicz S, Kwiatkowski A, Chmura A. Actinomycosis associated with perforation of jejunum in patient after cholecystectomy: a case report. Pol Merkuriusz Lek. 2010;29:318-9.

20. Belak J, Vajo J, Boor A, et al. Actinomycosis of the small intestine: an unusual cause of acute abdomen. Rozhl Chir. 2001;80(11):602-4. PMid:11794061.

21. Norwood MGA, Bown MJ, Furness PN, Berry DP. Actinomycosis of the sigmoid colon: an unusual cause of large bowel perforation. ANZ J Surg. 2004;74(9):816-8. PMid:15379826.

22. Jung EY, Choi SN, Park DJ, You JJ, Kim HJ, Chang SH. Abdominal actinomycosis associated with a sigmoid colon perforation in a patient with a ventriculoperitoneal shunt. Yonsei Med J. 2006;47(4):583-6. PMid:16941752.

23. Nunoo-Mensah JW, Joglekar VM, Nasmyth GD, Partridge SM. Abdominal actinomycosis: can early diagnosis prevent extensive surgery? Int J Clin Pract. 2010;64(1):106-9. PMid:20089023.

24. Ikeda SI, Kato T. A case of pelvic actinomycosis unrelated to an intrauterine device. Jpn J Clin Oncol. 2012;42(3):237-8. PMid:22375028.

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