2023 Volume 62 Issue 3 Pages 145-150
Background : Actinomycosis is a chronic suppurative granulomatous infection caused mainly by the anaerobic gram-positive bacillus Actinomyces israelli. It has been suggested to be associated with the long-term use of intrauterine devices (IUD) in female patients. We report a case of uterine actinomycosis diagnosed by smear cytology, even though uterine cancer was suspected on imaging, which was confirmed by confirmation of the presence of Actinomyces species in a uterine lavage specimen.
Case : A female patient in her 50 s visited a previous physician with the chief complaint of lower abdominal pain, and was referred to our hospital for further examination and treatment, because MRI revealed soft tissue shadows in the uterus with unclear borders extending into the rectum, which led to the suspicion of uterine cancer with rectal invasion. Examination of the patient revealed an IUD inserted 18 years earlier, which was removed. Cervical, endometrial, and IUD touch smear cytology revealed no malignant findings. Papanicolaou staining revealed a gray-blue bacterial mass in an inflammatory background. The patient was diagnosed as having pelvic infection caused by actinomycosis, and was treated with antibiotics for 6 months. Microbiologic analysis of an intrauterine lavage specimen confirmed the presence of Actinomyces mediterranea.
Conclusion : In patients with long-term IUD implantation, cytological diagnosis can lead to early diagnosis, even when imaging studies show soft tissue shadows in the pelvis. In this case, microbiologic analysis of an intrauterine lavage specimen confirmed Actinomyces mediterranea as the causative bacterium.
