Pelvic Actinomycosis Masquerading as Malignancy
Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by Actinomyces
israeli.
The opportunistic anaerobic bacterium Actinomycosis israeli is a normal part of the
human flora in the oropharynx, gastrointestinal and genital tract.
More than 50% of actinomycosis infections occur in the craniofacial region.
Pelvic infection accounts for 20% of human cases.
Actinomycosis secrete proteolytic enzymes, disrupt tissue planes
and compress surrounding tissues which makes their presentation
closer to a malignant process.
Slow growing nature of actinomyces, non-specific clinical presentation
and extensive spread before the diagnosis is made often pose a clinical challenge.
Owing to slow growing nature and chronic inflammatory process,
pre-operative diagnosis is difficult and is often made retrospectively
after surgical debulking. Infection is rare in infants and children.
Many cases are found in women using intra-uterine contraceptive device.
Actinomycosis is 3 times more common in men than women.
Absence of IUCD kept us from diagnosing actinomycosis.
Pic actinomyces often has complicated presentations
as in our case, the mass was pointing towards the malignant etiology.
The presenting features usually include fever, pelvic
pain or the incidental findings of suspicious pelvic masses on
imaging.
Ultrasound and CT are the most commonly used imaging modalities for diagnosing pelvic actinomycosis; however,
findings are usually nonspecific and thus unreliable in assisting
in the differential diagnosis.
CT findings in women with abdominal actinomycosis show predominantly solid masses with focal
areas of reduced attenuation or thick-walled cystic masses.
Our
patient presented with a unique symptom of vague abdominal
pain in combination of significant weight loss. Owing to paucity
of clinical clues preoperative diagnosis was in doubt hence with
patients of complex tubo-ovarian masses with features unclear
of malignant or inflammatory etiology a strong suspicion of
actinomycosis should be made.
Gynecol Obstet Res Open J. 2016; 3(2): 36-38. doi: 10.17140/GOROJ-3-135
