Case study: A 31-year-old with a copper intra-uterine device (IUD) in situ presented with left-sided pelvic pain and abnormal bloody vaginal discharge. A pelvic ultrasound demonstrated a 28×27×25 mm solid left ovarian lesion with marked internal blood flow, reported as an O-RADS (Ovarian-Adnexal Reporting and Data System) 5 lesion (>50% chance of malignancy). Her C-reactive protein level was 19 mg/L and tumour markers were negative. Microbiological culture of vaginal swabs and the removed IUD demonstrated normal vaginal flora only. She went on to have a laparoscopic left ovarian cystectomy with staging and peritoneal washings. Intra-operatively, ovarian adhesions and a purulent discharge from the left ovarian cyst were noted and sent for microbiology culture. Pathological examination showed suppurative and xanthogranulomatous inflammation of the ovary and omentum, with organisms resembling Actinomyces species, in keeping with pelvic actinomycosis. Microbiology from intraoperative culture grew Arachnia propionica . A prolonged course of amoxicillin was commenced based on microbial sensitivities.
Healsmith et al. (Sun,) studied this question.