Pelvic actinomycosis: A confusing diagnosis

Area of Science:

• Gynecology
• Infectious Diseases
• Microbiology

Background:

• Actinomycosis is a rare, chronic, suppurative infection caused by anaerobic Gram-positive bacteria, Actinomyces.
• Pelvic actinomycosis is exceptionally rare, accounting for 3% of human cases, and often associated with intrauterine device (IUD) contraception.
• Clinical presentation is non-specific, frequently mimicking gynecologic malignancies or pelvic abscesses, complicating diagnosis.

Purpose of the Study:

• To describe the clinical characteristics, diagnosis, and management of pelvic actinomycosis.
• To highlight the diagnostic challenges and potential for misdiagnosis with gynecologic malignancies.
• To emphasize the importance of accurate diagnosis for patient management and fertility preservation.

Main Methods:

• Retrospective and descriptive study of twelve patients diagnosed with pelvic actinomycosis.
• Data collection included patient demographics, IUD history, clinical presentation, diagnostic methods, and management strategies.
• Analysis focused on clinical suspicion, pre-operative diagnoses, and treatment outcomes.

Main Results:

• The study included twelve patients with a mean age of 47 years; 75% had a history of IUD use for a mean of 8.44 years.
• Pelvic pain was the most common symptom. Pre-operative diagnoses included tubo-ovarian abscess (4 cases) and suspected gynecologic malignancies (8 patients).
• Management involved a combination of surgery and long-term antibiotic administration.

Conclusions:

• Pelvic actinomycosis is a rare and diagnostically challenging chronic infection.
• Misdiagnosis can lead to unnecessary surgeries and complications.
• Accurate and timely diagnosis is essential to reduce morbidity, prevent complications, and preserve fertility.