title: Abdominopelvic actinomycosis in three different locations with invasion of the abdominal wall and ureteric obstruction: An uncommon presentation.
abstract: BACKGROUND
  Actinomycosis is a rare chronic infectious disease caused by Gram-positive anaerobic bacteria that normally colonize the bronchial system and gastrointestinal tract in humans. The most common diseases associated with actinomycosis are orocervicofacial, thoracic and abdominal infections involving Actinomyces israelii. Due to its rarity, its various clinical presentations and often-infiltrative characteristics in radiological imaging, it can easily be mistaken for other clinical conditions, including malignancy.
  
  
  METHODS
  We present an uncommon case of extended abdominopelvic actinomycosis with infiltrative lesions in multiple locations, including an abscess in the abdominal wall and ureteric obstruction, which underwent successful surgical and subsequent long-term antibiotic therapy.
  
  
  CONCLUSIONS
  To our knowledge, such a combination of different sites of manifestation has not yet been reported for actinomycosis in the presence of an IUD. Possible differential diagnoses included diverticulitis with covered perforation, pelvic inflammatory disease, tuberculosis and inflammatory bowel disease. The possibility of a malignant process required radical resection. As in most cases of actinomycosis, diagnosis could not be established with certainty until postoperative pathology investigation.
  
  
  CONCLUSIONS
  A rare actinomyceal infection should be considered in patients with a non-specific pelvic mass and atypical abdominal presentations, especially if a previous history of IUD usage is known.
authors.affiliation: Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
authors.forename: Christian L
authors.initials: CL
authors.lastname: Galata
authors.affiliation: Second Department of Internal Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
authors.forename: Roger
authors.initials: R
authors.lastname: Vogelmann
authors.affiliation: Institute of Pathology,University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Gaiser
authors.affiliation: Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.affiliation: Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany. Electronic address: karoline.horisberger@medma.uni-heidelberg.de.
authors.forename: Karoline
authors.initials: K
authors.lastname: Horisberger
keywords: Abdominopelvic actinomycosis; Intraabominal abscess; Intrauterine device; Ureteric obstruction