Intrauterine contraceptive device-related actinomycosis infection presenting as ovarian cancer with carcinomatosis.

BACKGROUND

Actinomycosis is a chronic granulomatous infection characterized by variable presentations, including disease states that can mimic neoplastic disease. A case is presented of actinomycosis that resembled metastatic carcinoma of the ovary.

METHODS

Case report and review of pertinent English-language literature.

CASE REPORT: A 52-year-old female presented with a four-month history of abdominal discomfort and general weakness, and a two-month history of weight loss (8 kg). She had no history of medical disease. She had undergone exploratory laparotomy in the past because of ectopic pregnancy and she had used an intra-uterine contraceptive device for many years. Abdominal-pelvic computed tomography (CT) and pelvic magnetic resonance imaging (MRI) revealed a 5.9 × 6.4 cm heterogeneous enhancing pelvic soft tissue mass with central necrosis, probably arising from the left adnexa, and was consistent with ovarian cancer. She also had multiple peripheral enhancing cystic lesions in the pelvis, abdominal wall, both paracolic gutters, the root of the small bowel mesentery, the omentum, and Morison pouch. She had a moderate amount of ascites with diffuse peritoneal thickening consistent with carcinomatosis. An exploratory laparotomy was performed, showing multiple large abscesses with adhesions and a large soft tissue mass in the left pelvic cavity. After resection and drainage, final pathology was reported as actinomycosis. After her operation, she was given intravenous penicillin for six weeks and discharged.

CONCLUSION

Surgeons and clinicians should be aware of this infectious disease because of its atypical symptoms and potential to mimic soft tissue tumors or malignant neoplasms.