Actinomycosis in a 70 year old woman with a forgotten intrauterine contraceptive device

Actinomycosis is an infectious disease that has been known since the late nineteenth century. In the pre-antibiotic era it was thought to be rather common but with increased use of antimicrobial agents its incidence has decreased significantly. The causative agent, most commonly Actinomyces israelii, is part of the commensal bacterial flora. It can infect any tissue, respects no tissue boundaries and can spread throughout the body. The clinical presentation of this illness can be similar to malignant disease and definite diagnosis is sometimes not apparent until after surgery and histologic examination. We report the case of a 71 year old woman who suffered from actinomycosis of the uterus and ovaries due to a forgotten intrauterine contraceptive device that had been in place for over four decades. The disease presentation was consistent with malignant disease and tumor markers, CA 125, CA 19-9 and CEA, measured in blood were elevated. She was treated successfully with total hysterectomy and bilateral salphingo-oophorectomy, as well as penicillin for six months.