Pelvic actinomycosis infection

Pelvic actinomycosis infection is rare but serious infection caused by Actinomyces sp, an opportunistic gram-positive bacteria usually introduced by foreign bodies specially IUCDs, surgery, or trauma. It generally falls under the broader spectrum of pelvic inflammatory disease.

Pelvic infection from several actinomyces sp can occur, which include:

The organisms are indigenous in the oral cavity, gastrointestinal tract, and genital tract, with opportunistic infection occurring when the mucosal barrier is broken.

Associations
  • placement of intra-uterine contraceptive devices: usually when it has been present for a prolonged period
    • approximately 25% of IUCDs eventually get colonised  by actinomycosis
    • 2-4% of IUCDs that are colonised ultimately develop a serious actinomycotic infection

Actinomycosis infection can mimic many other pelvic pathologies on imaging. The spread of infective/inflammatory change across tissue planes in particular retroperitoneal extension into the psoas muscle may suggest towards the diagnosis. Most common site of involvement in GI system is iliocaecal junction.

Other findings:

  • indurated pelvic fat
  • pelvic free fluid 
  • pelvic abscess
  • hydronephrosis
  • wider Intra-abdominal extension: mainly through contiguous spread
  • formation of tubo-ovarian abscesses 2
  • subsequent infertility

Treatment is usually with IV Penicillin in uncomplicated cases. The presence of an associated complication such as a tubo-ovarian abscess would warrant surgical intervention.

Due to its non specific imaging appearances, pelvic actinomyces infection can mimic several pathology such as:

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Article Information

rID: 13848
System: Gynaecology
Tag: cases
Synonyms or Alternate Spellings:
  • Pelvic actinomycotic infection
  • Actinomycotic infection of the pelvis
  • Pelvic actinomyces infection
  • Actinomyces infection of the pelvis

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