[Two women with a chronic process in the lower abdomen]

Two women, aged 50 and 45 years, had a chronic process in the lower abdomen. The first presented with cough and progressive dyspnoea, and her chest X-ray raised the suspicion of a metastasis of a malignancy. The second patient had abdominal pain, frequent urination and irregular vaginal bleeding. She was initially treated for a urinary-tract infection. Diagnostic investigations showed pelvic actinomycosis in both patients. Both had used an intrauterine device (IUD). In the first patient a pelvic abscess was drained. Antimicrobial treatment consisted of penicillin i.v. for several weeks and orally for 6 months. Actinomycosis is a slowly progressive bacterial infection that characteristically expands through anatomic structures and can lead to fistulae and abscesses. The disease is caused by Actinomyces species. Diagnosis is often delayed because other diseases (e.g. malignancy) are considered more probable. Actinomycosis is associated with prolonged use of an IUD, but it is rare and removal of the IUD is not indicated unless symptoms of pelvic inflammatory disease are present. The mainstay of actinomycosis therapy is administration of an effective antibiotic (e.g. penicillin). Except for drainage of abscesses, surgical intervention is rarely necessary. When antimicrobial therapy is continued for 6-9 months, prognosis is favourable, as was the case in both patients.