Actinomycosis of the appendix and pelvis: a case report.
BACKGROUND
Actinomycosis is a chronic infection caused by Actinomyces israeli, a gram-positive saprophytic anaerob, a normal inhabitant of the upper intestinal tract.


METHODS
We report a case of a 35-year-old female with an intrauterine device (IUD) who appeared in the emergency department with clinical characteristics of appendicitis. Ultrasound and computed tomography were performed, revealing an ovarian tumor formation and acute appendicitis. The patient underwent exploratory laparotomy, unilateral ovarectomy due to acute abscess and finally appendectomy. Diagnosis of actinomycosis was established with the presence of sulphur granules microscopically. The patient received penicillin for an extended period. Two years have passed and no clinical recurrence was mentioned.


CONCLUSIONS
Actinomycosis is not easily apparent because of its rarity. Inflammatory intestinal and pelvic disease can easily mislead the diagnosis, giving the impression of a neoplastic process. The drug of choice is penicillin, initiating a long-term aggressive therapy. The antimicrobial treatment lasts from 6 months to a year. Prognosis is very good. The role of IUD as a factor in the dissemination of the infection is very important. Physicians should be aware of actinomycosis in cases of abdominopelvic infiltrating masses.
Department of Obstetrics and Gynecology, Alexandra General Hospital, Athens, Greece. peitsidi@ath.forthnet.gr
Panagiotis
P
Peitsidis
Christos
C
Papadimitriou
Alexandros
A
Rodolakis
Aikaterini
A
Peitsidou
D015746:Abdominal Pain / Q000209:etiology; D000196:Actinomycosis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000382:microbiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects* / Q000382:microbiology; D010049:Ovarian Diseases / Q000382:microbiology* / Q000601:surgery; D010052:Ovariectomy