Systemic Actinomycosis Mimicking Pelvic Malignancy with Pulmonary Metastases

A 40-year-old woman presented with profound weight loss, anemia and multiple pulmonary nodules. Further investigation revealed a hepatic abscess and a pelvic mass associated with an intrauterine device. Cultures of the hepatic abscess and from peripheral blood demonstrated Actinomyces species. The patient underwent an exploratory laparotomy and hysterectomy. Pathological examination showed characteristic sulphur granules of actinomycosis. Long-term therapy with high-dose intravenous penicillin resulted in clinical and radiographic improvement.