[Pelvic pseudotumoral actinomycosis with multisegmental lumbosacral root failure. A case report]

Pelvic actinomycosis: A confusing diagnosis

Introduction and importance

Actinomycosis is a rare chronic and suppurative infection caused by anerobic Gram Positive bacteria: actinomyces. Pelvic location is extremely rare, usually associated with history of IUD contraception and doesn't have specific signs. Pelvic actinomycosis diagnosis may be confused with pelvic gynecologic malignancies or abscess. We present a retrospective and descriptive study of twelve patients with pelvic actinomycosis diagnosed and managed in our department from January 2000 to December 2011.

Cases presentation

The patients' mean age was 47 years. 75% of them had a history of IUD for a mean period of 8,44 years. Pelvic pain was the most common complaint. In four cases, pre-operative clinical presumption was tubo-ovarian abscess. Gynecologic malignancies were suspected in 8 patients. Pelvic actinomycosis management was based on surgery and long-term antibiotic.

Clinical discussion

Pelvic actinomycosis is an extremely rare chronic infection, presenting 3% of human actinomycosis. Common clinical presentations include vaginal discharge, tubo-ovarian abscess and pelvic tumors mimicking gynecologic malignancies. It is difficult to diagnose. Association with IUD history was recognized. Management is based on surgery and long-term antibiotic administration.

Conclusion

Pelvic actinomycosis is an extremely rare chronic infection. This entity is difficult to diagnose. Accurate diagnosis can reduce complications and unnecessary surgeries, and can preserve fertility.

[Pseudo tumor pelvic actinomycosis associated with intrauterine device: report of three cases]

L'actinomycose est une maladie chronique suppurative granulomateuse d'origine infectieuse responsable d'un syndrome tumoral. La localisation pelvienne est rare et souvent associée, chez la femme, au port au long court du dispositif intra-utérin (DIU). Le diagnostic préopératoire n'est possible que dans 17% des cas. Nous rapportons trois observations, d'actinomycose pelvienne pseudo tumorale compliquées chez des femmes porteuses de DIU, qui illustrent le rôle de ce moyen de contraception dans la genèse de cette pathologie ainsi que les difficultés de prise en charge.

Para-iliac actinomycetoma presenting as sarcoma, a late complication of appendicitis: A case report

INTRODUCTION

Actinomycosis is known to mimic several types of neoplasms, leading to morbid surgical interventions.

PRESENTATION OF CASE

We report the particular case of an extensive right para-iliac actinomycetoma presenting as a sarcoma, which to our knowledge has not yet been described in the literature, in a patient with previous ruptured appendicitis. Thanks to the collaborative work between the orthopedic and general surgeons, pathologist and microbiologist, the diagnosis of actinomycosis was made pre-operatively, saving this 15-year-old patient from a tumor resection protocol.

DISCUSSION

Actinomycetomas have often been reported to present in the same way as several abdominal and gynecological neoplasms, and on rare occasions been described as mimicking other soft-tissue sarcomas, leading to unnecessary morbid tumor resection protocols. The most common cause of abdominal actinomycosis is perforated appendicitis, and may present several years later.

CONCLUSION

While faced with a soft tissue mass transgressing tissue planes and possibly extending to the region of the right lower quadrant, especially with a history of previous perforated appendicitis, one should consider the possibility of an abscess caused by pathogens of intestinal origin, including the gram positive anaerobe Actinomycosis israelii. Failure to actively search for this pathogen, which is not detectable with routine staining techniques and may take up to 1–2 weeks to isolate, may lead to unnecessary morbid surgical procedures.

Actinomycose pelvienne : à propos de deux cas

INTRODUCTION

Actinomycosis is a chronic suppurative granulomatous disease caused by different Actinomyces species, mostly bacillus: the Actinomyces israeli. The pelvis location of this infection is rare.

OBSERVATIONS

We report two cases of actinomycosis that were diagnosed after the surgical treatment of a suspected ovarian tumor and a suspected acute peritonitis. Diagnosis in both cases was based on the histopathologic findings.

CONCLUSION

The incidence of pelvic actinomycosis is increasing since 1960 related to the frequent use of intra uterine device. The clinical symptomatology is not specific, simulating a neoplastic or an inflammatory process. The treatment combines operative and antibiotic therapy.