When pelvic actinomycosis mimics cervical neoplasia: A diagnostic challenge.

Pelvic actinomycosis is an uncommon infection caused by Actinomyces israelii, often linked to prolonged intrauterine device (IUD) use. Its clinical and radiologic presentation may closely mimic pelvic malignancies, leading to misdiagnosis and inappropriate management. We report two cases of pelvic actinomycosis initially mistaken for cervical cancer. The first involved a 50-year-old woman with pelvic pain and imaging suggestive of advanced cervical neoplasia; histology revealed Actinomyces infection, and antibiotic therapy led to complete resolution. The second concerned a 76-year-old woman with a cervical mass and metabolic uptake on PET scan, ultimately diagnosed as actinomycotic cervicitis after IUD removal and microbiological confirmation. Both patients improved with prolonged antibiotic treatment. Awareness of this rare entity is essential to prevent unnecessary radical surgery and to ensure timely conservative management.