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[Two women with a chronic process in the lower abdomen]
J van de Lande1, L Spanjaard, M P Burger
1Afd. Verloskunde en Gynaecologie, Academisch Medisch Centrum/Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam.
Nederlands Tijdschrift Voor Geneeskunde
|December 18, 2003
Summary
Pelvic actinomycosis, a rare infection linked to intrauterine devices (IUDs), can mimic malignancy. Prompt diagnosis and long-term penicillin treatment lead to favorable outcomes for this chronic bacterial infection.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Gynecology
Background:
- Actinomycosis is a chronic, slowly progressive bacterial infection caused by Actinomyces species.
- It characteristically spreads through tissues, potentially causing abscesses and fistulae.
- Diagnosis can be challenging due to its insidious nature and resemblance to other conditions like malignancy.
Observation:
- Two women, aged 45 and 50, presented with chronic lower abdominal symptoms.
- Initial symptoms included cough, dyspnea, abdominal pain, urinary frequency, and vaginal bleeding, leading to misdiagnosis.
- Both patients had a history of intrauterine device (IUD) use, a known risk factor for pelvic actinomycosis.
Findings:
- Diagnostic investigations confirmed pelvic actinomycosis in both patients.
- One patient had a pelvic abscess that required drainage.
- Treatment involved intravenous and oral penicillin for an extended duration (6 months).
Implications:
- Pelvic actinomycosis associated with IUD use, though rare, requires high clinical suspicion for timely diagnosis.
- Long-term antibiotic therapy, primarily penicillin, is the cornerstone of treatment.
- Surgical intervention is typically limited to abscess drainage, with a favorable prognosis following adequate antimicrobial treatment.