A rare case of pelvic actinomycosis mimicking an ovarian malignancy

Actinomycosis is a rare chronic infectious disease caused by Actinomyces species. Orocervicofacial actinomycosis is the most common presentation (50%), followed by thoracic disease (15%-20%) and abdominopelvic disease (20%). It poses great diagnostic dilemma due to its variable presentations. We present a case of a 45-year-old female who presented with complaints of abdominal pain, abdominal fullness, constipation, weight loss and loss of appetite for the past 1 year. On examination, the patient was found to have palpable mass in lower abdominal region measuring about 10 cm × 12 cm, nontender, immobile mass. Patient was seen initially at another hospital, where ovarian malignancy was suspected in view of large size and radiological findings. Laparotomy was done but in view of adhesions and vascularity, multiple biopsies were taken and abdomen was closed. The patient was diagnosed to have actinomycosis based on histopathology and was treated accordingly. This case stresses on the diagnostic importance of clinical suspicion of actinomycosis in patients presenting with long-standing abdominal complaints, especially with history of previous surgeries.