Pelvic actinomycosis: a malignant appearing mass. A case report

Pelvic actinomycosis is a rare complication of a long-term intrauterine contraceptive device. Early diagnosis is important, as clinical and radiological imaging may mimic a malignant pathology and lead to radical and unnecessary surgery. We report a case of pelvic actinomycosis in a woman who had used an intrauterine contraceptive device for the last 13 years. The actinomycosis appeared as a malignant pelvic mass with invasion into the sigmoid and left ureter, with high-grade stenosis of these structures. Because of its rapidly developing obstructive character, an urgent Hartmann procedure with resection of the uterus and both ovaries was performed. Histology revealed actinomycosis. With this case we want to illustrate that for a woman presenting with an intrauterine contraceptive device and a malignant appearing mass in the pelvis, pelvic actinomycosis must be considered in the list of differential diagnosis, so that appropriate diagnostic work out and treatment can be made.