Pelvic Actinomycosis; the Disease for Which Diagnostic and Therapeutic Delay is Still Being Experienced

Actinomyces is a gram-positive bacteria, which presents as a normal flora member at mucosal areas. Because of its unexpected localization, malignancy is the clinical prediagnosis for more than half of the pelvic cases, and unnecessary extended surgery is performed in these patients. In this report, we present a case of a premenopausal woman with an abdominal mass, who had a pre-operative diagnosis of malignancy, but a post-operative histopathologic diagnosis of pelvic Actinomycosis. Although the clinical appearance resembles a malignancy, for the patient with intrauterine device (IUD) history, distinctive aspect of the pelvic Actinomycosis should absolutely be considered. After the diagnosis is established, the infection source IUD should be removed and long term high dose penicillin therapy should be administered.  Surgery should be considered only if malignancy cannot be certainly excluded, if abscess drainage is necessary and if necrotic tissues and sinuses should be remove