Bandyopadhyay Subhayu, Sinha Sanjay, Wui Chien Patrick Fan, Fleming Dawn
Department of Obstetrics & Gynaecology;
Department of pathology, Ninewells Hospital, Dundee, UK.
Clin Pract. 2011 Nov 25;1(4):e112. doi: 10.4081/cp.2011.e112. eCollection 2011 Sep 28.
Actinomycosis has been recognized to be associated with the use of intrauterine contraceptive device. We are reporting a case where a patient with severe pelvic actinomycosis presented with the clinical picture of an ovarian tumour. A 44-year-old lady attended the A&E with progressively worsening lower abdominal pain. A computerized tomography (CT) scan showed the presence of a large pelvic mass, right hydronephrosis and prominent para-aortic lymph nodes and an elevated C-reactive proteine (CRP) and white cell count (WCC). When there was no improvement with antibiotic therapy, a laparotomy was performed, where bilateral tubo-ovarian abscess and dense adhesions were found. A subtotal hysterectomy, bilateral salpingoophorectomy and small bowel resection was performed. Histopathology of the specimen confirmed the diagnosis of actinomycosis. The case highlighted the diagnostic dilemma for ascertaining the nature of the pelvic mass in this patient. Due to its invasion of surrounding tissues and the formation of masses severe infection is often confused with an ovarian neoplasm.
放线菌病已被认为与宫内节育器的使用有关。我们报告一例严重盆腔放线菌病患者表现出卵巢肿瘤的临床症状。一名44岁女性因下腹部疼痛逐渐加重而到急诊就诊。计算机断层扫描（CT）显示盆腔有一个大肿块、右侧肾积水、主动脉旁淋巴结肿大，且C反应蛋白（CRP）和白细胞计数（WCC）升高。抗生素治疗无效后，进行了剖腹手术，发现双侧输卵管卵巢脓肿和致密粘连。实施了次全子宫切除术、双侧输卵管卵巢切除术和小肠切除术。标本的组织病理学证实为放线菌病。该病例凸显了确定该患者盆腔肿块性质时的诊断困境。由于其侵犯周围组织并形成肿块，严重感染常被误诊为卵巢肿瘤。
