Pelvic actinomycosis associated with intrauterine devices.

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Abstract
The authors describe two women with pelvic pain, long-term use of an intrauterine device, and a pelvic mass due to Actinomyces israelii. The diagnostic imaging findings were nonspecific but included mass effect and mucosal irregularity of the rectosigmoid colon at barium enema examination and complex masses and inflammatory changes at computed tomography and magnetic resonance imaging. Radiologists should be aware of the imaging findings of this potentially lethal but curable condition. 2 cases of pelvic Actinomycosis both in women 40 years of age, with IUDs in place for 8 and 10 years respectively, were diagnosed with the aid of radiologic techniques including barium enema, computed tomography (CT) and magnetic resonance imaging (MR). The 1st woman had experienced malaise, night sweats and a weight loss of 15 lb. over 2-3 months, then felt an epigastric mass for 5 days. She has endometritis, elevated white blood cell count, and large, tender, bilateral adnexal masses. Inflammatory changes and multilocular fluid collections were demonstrated by enhanced CT. Aspiration of the epigastric mass yielded sulfur granules and anaerobic bacteria. She was successfully treated with penicillin, gentamycin and clindamycin. The 2nd woman had a 2-month history of abdominal pain, a pelvic mass and an elevated white blood cell count. Enhanced CT, barium enema and sigmoidoscopy demonstrated a mass between the uterus and bowel, with mural invasion of the sigmoid colon. A 5 x 6 cm left-sided tubo-ovarian abscess adhering to the colon, bladder and left pelvic sidewall was excised at laparotomy. She remained asymptomatic at 6 months. This lethal but curable condition is caused by Actinomyces israelii, an opportunistic gram-positive bacteria usually introduced by foreign bodies, surgery or trauma. CT and MR were helpful in diagnosing the relatively nonspecific signs and symptoms in these cases.