[Abdominopelvic actinomycosis in an intrauterine device user: treatment with ceftriaxone (letter)]

A case of abdominopelvic actinomycosis in a 34-year-old woman who had used an IUD for 5 years was successfully treated with ceftriaxone previously reported only in treatment of thoracic actinomycosis. The patient had expelled the IUD 1 week prior to hospitalization which was motivated by discovery of a mass in the right iliac fossa without other clinical history. A painful 4 cm mass was observed on physical examination. The pathologists report after laparotomy indicated fibrosis and inflammation necrosis and abscess related to colonies of Actinomyces affecting the mesentery ileum and appendix. The patient refused treatment with penicillin which would have required lengthy hospitalization. Home treatment with ceftriaxone 2g/day for 3 weeks was substituted which led to clear improvement of the lesions on CAT scan. The patient refused further treatment but returned spontaneously 6 months later and was asymptomatic. Treatment of invasive forms of pelvic actinomycosis is based on surgery and a minimum of 3 months of postsurgical antibiotic treatment. Penicillin is the drug of choice although other drugs have proven effective in shorter courses of treatment for thoracic actinomycosis. Further studies of alternative drugs should be conducted in pelvic cases.