Can Surgery Be Avoided? Exclusive Antibiotic Treatment for Pelvic Actinomycosis

Area of Science:

• Gynecology
• Infectious Diseases
• Medical Imaging

Background:

• Pelvic actinomycosis is a rare, chronic granulomatous infection often associated with intrauterine devices (IUDs).
• Its nonspecific clinical and radiological features can lead to misdiagnosis as pelvic or intra-abdominal malignancy, potentially resulting in extensive surgery.
• Preoperative diagnosis is infrequent, and surgical intervention is typically required.

Observation:

• A 42-year-old female with a 15-year history of IUD use presented with symptoms suggestive of pelvic actinomycosis.
• The patient underwent preoperative diagnosis via paracentesis, a rare and unique approach for this condition.
• Treatment was conservative, involving prolonged antibiotic therapy without surgical intervention.

Findings:

• The patient achieved almost complete radiologic resolution of the inflammatory mass within one year.
• Nutritional recovery and complete symptom absence were observed post-treatment.
• This case demonstrates successful medical management of pelvic actinomycosis.

Implications:

• Pelvic actinomycosis associated with IUDs can be diagnosed preoperatively using methods like paracentesis.
• Conservative management with prolonged antibiotic therapy is a viable and effective alternative to surgery.
• This approach can prevent high-morbidity surgical interventions and improve patient outcomes.