[Tubo-ovarian actinomycosis the IUD and chemotherapy for breast cancer]

A case of actinomycotic tubo-ovarian abscess is described in a 49-year-old breast cancer patient who had used an IUD for 17 years. The breast cancer diagnosis overshadowed discovery of actinomyces on a cervical smear 10 months prior to the actinomycosis diagnosis. The woman was treated with chemotherapy and radiation for the cancer. The IUD was removed 3 months after completion of chemotherapy because of persistent amenorrhea. 1 month later the woman sought emergency treatment for abdominal pain. A fixed pelvic mass was discovered. Examination under general anesthesia confirmed a voluminous mass with reduced uterine mobility. A transversal laparotomy was performed given the size of the lesion. The peri-operative diagnosis was voluminous pelvic abscess with contralateral salpingitis. A total hysterectomy with bilateral salpingectomy and appendectomy was performed. Pulmonary radiography showed no extension of actinomyces. The patient was discharged on the 8th day with Clamoxyl (amoxicillin). No recurrence of actinomyces or breast cancer was detected in 2 years of follow-up. Presence of actinomyces on a cervical smear may signal risk of developing actinomycosis. It is not possible to confirm a relationship between chemotherapy and actinomycosis on the basis of one patient. Given the rarity of the association chemotherapy does not seem to contraindicate IUD use in women with breast cancer undergoing chemotherapy. They should however be carefully followed.