Actinomycosis in a Postmenopausal Patient

Abstract

Introduction: Pelvic actinomycosis is an uncommon chronic bacterial infection caused by Actinomyces israelii. There is a strong association between the long-term use of intrauterine devices (IUDs) and the development of this condition. It is rare in postmenopausal women and may present insidiously, which can lead to a delayed diagnosis.

Objective: To present the clinical case of a postmenopausal patient with pelvic actinomycosis.

Clinical Case: A 55-year-old female patient, with a history of an intrauterine device inserted 30 years prior, presented with a one-year history of abdominal pain and weight loss. An abdominal ultrasound revealed bilateral ovarian masses. During laparotomy, a frozen pelvis appearance, suggestive of actinomycosis, was observed; a total hysterectomy with bilateral salpingo-oophorectomy was performed. Treatment with parenteral penicillin was initiated. Pathology confirmed the presumptive diagnosis through the identification of sulfur granules in the surgical specimen. Medical treatment with antibiotics was continued, and the patient was discharged at her three-month follow-up visit.

Conclusions: This case is considered an unusual presentation for three reasons: the low incidence of Actinomyces infections, the atypical clinical presentation, and the rarity of pelvic actinomycosis in postmenopausal women.