[Pelvic actinomycosis: Diagnostic and therapeutic aspects]

Area of Science:

• Gynecology
• Infectious Diseases
• Pathology

Background:

• Actinomycosis is a rare granulomatous suppurative disease, infrequently diagnosed preoperatively due to challenging clinical presentations.
• Pelvic actinomycosis, though rare, is more prevalent in women, often associated with intrauterine device (IUD) usage.
• Early diagnosis is crucial for effective therapeutic strategies and avoiding extensive surgical interventions.

Purpose of the Study:

• To review cases of pelvic actinomycosis diagnosed at Ben Arous hospital between 2003 and 2013.
• To highlight the clinical, imaging, and pathological features of pelvic actinomycosis.
• To emphasize the importance of considering actinomycosis in differential diagnoses for pelvic masses and infections.

Main Methods:

• Retrospective review of medical records of women presenting with pelvic pain syndrome.
• Inclusion criteria: suspected actinomycosis based on clinical and imaging findings, confirmed by pathology.
• Focus on cases diagnosed between January 2003 and December 2013.

Main Results:

• Eight cases of gynecologic abdominopelvic actinomycosis were diagnosed.
• Seven patients (87.5%) used an IUD for an average of 5 years.
• Clinical presentations included pelvic pain, fever, pelvic tumors, abscesses, or pelvic inflammatory disease; imaging was rarely diagnostic.
• Histopathology confirmed diagnosis in all cases; penicillin treatment resulted in favorable outcomes.

Conclusions:

• Actinomycosis should be suspected in invasive abdominal masses with neoplastic appearance.
• Consider actinomycosis in genital infections, especially in patients with IUDs for 5 years or more.
• Prompt diagnosis and antibiotic therapy are key to successful management and avoiding unnecessary surgery.