A Case of Pelvic Actinomycosis with Hepatic Actinomycotic Pseudotumor

Pelvic actinomycosis in women most commonly occurs during ascending infections, usually associated with intrauterine devices (IUDs). However, secondary hepatic actinomycosis is very rare. A 47-year-old woman using IUDs for 18 years was referred under the impression of ovarian cancer. Further investigation revealed a hepatic tumor diagnosed as an inflammatory pseudotumor by fine needle aspiration biopsy, and a pelvic mass diagnosed as pelvic actinomycosis by sulfur granules in bilateral adnexa gained by an explorative laparotomy. Long-term therapy with high-dose intravenous penicillin and oral amoxicillin resulted in clinical and radiological improvement. The management of pelvic actinomycosis is based on a medical approach, although it sometimes requires surgical intervention. However, the necessity for surgical treatment is controversial in cases of secondary hepatic actinomycosis.