The abdominal collection was sampled confirming actinomycosis due to longstanding IUD.

Actinomycosis is a chronic granulomatous infection by Actinomyces israelii, a normal colonizer of the female genital tract. The IUD causes mucosal microtrauma and organism gains access to female genital tract, and often presents after several months of symptoms. Patient can have leukocytosis and elevated CRP.

The appearance can be variable and confused for cancer, including solid, complex, and cystic masses. It is treated with drainage and long term penicillin.