Abdominal wall actinomycosis associated with an IUD. A case report.

ABSTRACT

PIP: This paper presents the 1st reported case of actinomycosis of the subcutaneous tissues and abdominal wall without pelvic organ involvement in an IUD user. The patient, a 39-year old woman, para 4-0-1-4, presented with lower abdominal pain. Pap smear findings were reported as cervical intraepithelial neoplasia, grade I-II, and endocervical curettage showed colonies of Actinomyces species. A subsequent cone biopsy revealed carcinoma in situ but no evidence of Actinomyces. The final diagnosis was cervical intraepithelial neoplasia, leiomyomata, and actinomycotic abscesses of the abdominal wall. It is suggested that systemic actinomycosis be included in the differential diagnosis of pain in IUD users when Actinomyces is found on Pap smears or in endocervical curettings. Treatment of actinomycosis generally involves intravenous aqueous penicillin, 10-20 million units/day for 4-5 days, followed by 2-15 million units/day of oral penicillin for 3 weeks-1 year. Longterm antibiotic therapy is particularly important prior to any surgical intervention. If left untreated, actinomycosis can lead to infection, brain abscess, or death.