Computed tomography guided core needle biopsy diagnosis of pelvic actinomycosis

Background. Pelvic actinomycosis is a chronic suppurative inflammatory dise ase caused by the anaerobic Gram-positive bacilli Actinomyces israelii. The propensity of this disease to simulate gynecological malignancies has been described previously. The great majority of these patients were diagnosed with actinomycotic diseases during or after exploratory laparotomy, but rar ely preoperatively. We reviewed the literature pertaining the management of pelvic actinomycosis. Case. A nulliparous woman with a long history of intrauterine contraceptive device (IUD) and recent Papanicolaou smear findings consistent with the pr esence of actinomyces presented with chronic vague lower abdominal pain, we ight loss, poor appetite, and recent increase in abdominal girth associated with a large immobile pelvic mass. Transcutaneous computed tomography guid ed core needle biopsy established the diagnosis of pelvic actinomycosis obv iating immediate surgical intervention. Intravenous and subsequent long-ter m oral penicillin therapy was constituted and resulted in a significant dec rease in the size of the pelvic mass. Conclusion. In patients presenting with pelvic masses and a history of IUD placement, actinomycotic infection should be considered and diagnosis attem pted by imaging guided needle biopsy. Furthermore, this case suggested that correct nonsurgical diagnosis of pelvic actinomycosis followed by prolonge d antibiotic therapy might eliminate the need for extensive extirpative sur gery and assist in maintaining future fertility, (C) 2000 Academic Press.