Journal of Global Infectious Diseases

LETTER TO EDITOR
Year
: 2012  |  Volume : 4  |  Issue : 4  |  Page : 222--223

Ovarian actinomycosis: Presenting as ovarian mass without any history of intra-uterine copper device


Sunita Singh, Ashima Batra, Shivani Dua, Amrita Duhan 
 Department of Pathology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India

Correspondence Address:
Sunita Singh
Department of Pathology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana
India




How to cite this article:
Singh S, Batra A, Dua S, Duhan A. Ovarian actinomycosis: Presenting as ovarian mass without any history of intra-uterine copper device.J Global Infect Dis 2012;4:222-223


How to cite this URL:
Singh S, Batra A, Dua S, Duhan A. Ovarian actinomycosis: Presenting as ovarian mass without any history of intra-uterine copper device. J Global Infect Dis [serial online] 2012 [cited 2019 Oct 16 ];4:222-223
Available from: http://www.jgid.org/text.asp?2012/4/4/222/103904


Full Text

Sir,

Female genitalia is relatively a rare site for pelvic actinomycosis, the detection rate being as low as 2%. Pelvic actinomycosis is often unsuspected clinically, as actinomyces do not inhabit the vaginal canal. Adnexal involvement is usually secondary to infection in the gastrointestinal canal. [1] Two large studies examining cervical smear samples show that actinomyceal colonization of the female genital tract does not occur in the absence of Intra-Uterine Copper Device (IUCD) usage. [2],[3] We discuss a case of a patient with ovarian actinomycosis who presented with ovarian mass and underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy for the same. A 40-year-old woman, para 3, with no history of IUCD sought medical attention for pain in lower-left abdomen for past 6 months that was associated with burning micturation and painful defecation. On abdominal examination, a firm, tender, fixed mass of size 3Χ3 cm was palpated in the left iliac fossa. On vaginal examination, the mass was palpable in the left fornix and was found to be extending into the pouch of Douglas. A clinical diagnosis of tubo-ovarian mass was made. The total leukocyte count was markedly elevated (25,000/cmm). The C-reactive protein concentration (29 mg/dl) was elevated. CA-125 was within the normal range. Ultrasonography revealed thickening of gut loops in the infraumblical and left iliac fossa. The Contrast enhancement computer tomography (CECT) scan revealed heterogeneously enhancing mass abutting peritoneum in the pelvis indenting urinary bladder and separate from bowel, measuring 6.5Χ3.5Χ4 cm with a nonenhancing cystic lesion on the right side. Another similar lesion measuring 2.9Χ2Χ2 cm was found in the infraumblical region with mild adjacent gut thickening. The patient underwent exploratory laprotomy. An ovarian mass was detected for which total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The histopathological examination of the left ovary revealed characteristic actinomycotic granules (sulfur granules) [Figure 1] and [Figure 2]. Postoperatively, the patient was treated with intravenous piperacillin and tetracycline for 1 week and then oral penicillin for 4 weeks, and the postoperative course was uneventful. {Figure 1}{Figure 2}

Actinomycotic infections are endogenous in origin. The organism normally present is of low pathogenicity and multiplies in a favorable environment provided by the injured necrotic tissue. [1] Ovarian actinomycosis is rarer because the structure of the ovary is resistant to surrounding inflammatory disease. [4] It has been assumed that bacteria enter the ovary when its surface is broken by the process of ovulation. It is difficult to diagnose the condition clinically. The diagnosis is done on pathological, serological, and bacteriological examinations. Timely detection and treatment prevents complications such as pelvic actinomycotic masses leading to frozen pelvis. A delay in diagnosis can even be fatal. [5]

When actinomycosis is diagnosed early and treated with appropriate antibiotic therapy, the prognosis is excellent. The more advanced and complicated actinomycotic forms require antibiotic and surgical therapy for optimal outcome; however, death can occur despite such therapy. It is also important to look for infection at other sites. To minimize delay in diagnosis, actinomycosis should be considered in the differential diagnosis of any inflammatory lesion of subacute or long-term nature.

 Acknowledgement



We acknowledge Dr. Nisha Marwah and Dr. Rajeev Sen for their valuable help in data collection and final review of the manuscript.

References

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2Valicenti JF, Pappas AA, Graber CD, Williamson HO, Willis NF. Detection and prevalence of IUD-associated Actinomyces colonization and related morbidity. A prospective study of 69,925 cervical smears. JAMA 1982;247:1149-52.
3Chatwani A, Amin-Hanjani S. Incidence of actinomycosis associated with intrauterine devices. J Reprod Med 1994;39:585-7.
4Koshiyama M, Yoshida M, Fujii H, Nanno H, Hayashi M, Tauchi K et al. Ovarian actinomycosis complicated by diabetes mellitus simulating an advanced ovarian carcinoma. Eur J Obstet Gynecol Reprod Biol 1999;87:95-9.
5Munot MV, Tambekar R, Veerkar V, Shinde P. Actinomycotic salphingitis: A complication of misplaced Cu-T. J Obstet Gynecol India 2007;57:442-3.