Actinomycotic Endometritis

Seven cases of actinomycotic endometritis were identified among 28,906 endometrial biopsies performed in the last 10 yr. The patients' ages ranged from 44 to 85 yr old. An intrauterine device was in place from 7 to 44 yr. The reasons to perform the biopsies included abnormal uterine bleeding, malodor, prolapse, pelvic inflammatory disease, and suspicion of metastatic uterine sarcoma. Definitive identification of Actinomyces israelii by culture was obtained in 1 case only. Gram, Gomori methenamine silver, and Fite stains were useful in the differential diagnosis with pseudoactinomycotic granules, Nocardia, fungi, and other bacteria. The Actinomyces-like organisms were surrounded by extensive suppurative reaction in all cases. The tissues showed florid neutrophilic and plasmacytic inflammation. The treatment consisted of intrauterine device removal and 10 to 30 d of antibiotics in 4 patients. The Actinomyces-like organisms persisted for 6 wk in spite of antibiotic therapy when the intrauterine device removal was delayed in one of those cases. Two patients had hysterectomy and salpingo-oophorectomy due to tubo-ovarian abscess and hysterectomy, salpingo-oophorectomy, and rectosigmoid excision due to pelvic abscess and septic emboli, both followed by 30 to 45 d of antibiotic therapy. One patient had hysterectomy not followed by antibiotics due to prolapse. No other pelvic abscesses were identified on follow-up, which ranged from 4 to 101 mo (median, 20 mo; mean, 44 mo).