Abdominal and pelvic actinomycosis: A challenging diagnosis with tumor-mimicking imaging – A case report

We report a case of actinomycosis of the abdomen and pelvis in a 64-year-old woman with an intrauterine contraceptive device (IUD), caused by Actinomyces Israeli. Pelvic actinomycosis of the female genital tract is a rare suppurative infection, increasingly associated with the use of IUDs, involving adnexal tissues and occasionally the endometrium. In patients with intrauterine contraceptive devices or those who have recently removed them, abdominal pain, recurrent vaginal bleeding, or adnexal masses should trigger a careful investigation for potentially pathogenic Actinomyces in the genital tract, as promptly differentiating this infection from a neoplastic condition is crucial both to ensure a positive outcome for the patient and to prevent unnecessary surgeries that might impact the fertility of pre-menopausal women. The diagnosis is typically established through exploratory laparotomy in cases of severe abdominal pain and signs indicative of acute abdomen; alternatively, it may be pursued for persistent abdominal pain and signs consistent with pelvic malignancy, like the presentation observed in our patient. This case report highlights an unusual instance of extensive pelvic actinomycosis affecting abdominal organs in a patient with an IUD, mimicking a neoplastic condition.