Hellenic Journal of Surgery 88 Pelvic Actinomycosis: A Rare Presentation Madhumita Mukhopadhyay, Dipan Mukhopadhyay, Kaushik Mandal, Mandeep Bedi Hellenic Journal of Surgery (2016) 88:4, 276-277 Madhumita Mukhopadhyay MBBS, MS Dept. of Surgery, Burdwan Medical College and Hospital, West Bengal Dipan Mukhopadhyay MBBS, MS Dept. of Surgery, Calcutta National Medical College and Hospital, Kolkata Kaushik Mandal MBBS, MS Dept. of Surgery, Burdwan Medical College and Hospital, West Bengal Mandeep Bedi MBBS, MD Dept of Pathology, Kolkata Police Hospital, Kolkata Corresponding author: Madhumita Mukhopadhyay Block 2, 7A, Ekta Heights, 56, Raja S C Mullick Road Kolkata- 700032, West Bengal, India e-mail: drmmeettuu@yahoo.co.in Received 16 April 2016; Accepted 25 May 2016 CASE REPORT Abstract Pelvic actinomycosis is a rare presentation which may present as a diagnostic dilemma when it mimics pelvic ma- lignancy or sometimes may be overlooked because of its non-specific nature. We present the case of a 37-year-old female patient who presented with tubo-ovarian actinomycosis without a history of IUD use. She presented with abdominal pain and bilateral tubo-ovarian masses. Postoperative histopathology revealed actinomycosis. Key words: Actinomycosis; pelvic disease; tubo-ovarian actinomycosis was found with dense adhesions to the surrounding pelvic structures. On the right side, a smaller tubo-ovarian mass was also found adherent to the surrounding structures. The adhesions were separated and a hysterectomy was performed with bilateral salpingo-oophorectomy (Figure 1). Histopathology of the right tubo-ovarian mass revealed dense infiltration by inflammatory cells. Sulphur granules of actinomycosis could be seen (Figure 2). The left tubo- ovarian mass also showed dense infiltration by inflam- matory cells. Postoperatively, the patient was treated with the appropriate antibiotics. The patient is currently under follow-up. Discussion Actinomycosis is caused by actinomyces israellii. It is a chronic suppurative and granulomatous bacterial infec- tion [5] that is characterized by the formation of abscesses, multiple draining sinuses and appearance of tangled mycelia masses or granules in the discharge or tissue sections [6]. Actinomyces israellii, as other actinomyces species, are saprophytes in the female genital tract [7]. The destruc- Introduction Pelvic actinomycosis is uncommon and may present as a diagnostic dilemma because of an atypical clinical presentation. Tubo-ovarian actinomycosis is insidious in its course and often presents as a pelvic mass that mimics a pelvic malignancy [1-3]. Pelvic actinomycosis without a history of intra-uterine device (IUD) use is very rare [4]. We present the case of a 37-year-old female patient who presented with tubo-ovarian actinomycosis while never having used an IUD. Case Presentation A 37-year-old female patient presented with a history of lower abdominal pain of one year duration. She had no history of IUD use. Physical examination revealed tenderness in the lower abdomen. Vaginal examination revealed a palpable mass in the left fornix. Pelvic ultrasonography showed a complex Space Occupying Lesion (SOL) in the left adnexa measur- ing 73 × 52 × 42 mm as well as a smaller right ovarian cyst. Laboratory tests revealed leucocytosis. The patient did not have any history of sexually transmitted diseases. At exploratory laparotomy, a left tubo-ovarian mass Figure 1. Bilateral tubo-ovarian mass.