[Anatomoclinical confrontation: abdominal pains, fever and pelvic tumor in a young female patient with an intra-uterine device].

The case history of a 39-year old female nurse hospitalized with pains in the lower abdominal quadrant especially in the hypogastric area with persistent elevation of temperature is presented. Previous medical history included dermatitis traced to her professional environment containing antibiotics an episode of cholecysto-cholangitis and hemorrhoidectomy. Echographic examination of the abdomen showed normal uterus slightly swollen right ovary with a 4-5 cm long formation symptomatic of Crohns disease. No intraperitoneal fluid loss was detected. Gynecological anamnesis disclosed the presence of an IUD device. After its surgical ablation erythromycin p.o. Trimeton hydroelectrolytic glucose solution was administered resulting in the drop of temperature. Fever again reappeared 12 hours later and controlled echography revealed a 2 cm long fluid-containing formation in the right ovary. Exploratory laparotomy was performed due to the sudden increase of temperature and tachycardia. In the retroperitoneal space and on the omentum numerous fibrous nodules indicative of neoplastic dissemination were found. Excision of one nodule of the omentum revealed chronic inflammation. In spite of this the surgeon convinced of the neoplastic nature of the disease due to the difficulty of differentiation from other ailments proceeded to excise the whole 9 cm mass containing numerous necrosis sites on its surface. Histological examination indicated inflammation typical of actinomycosis caused by Actinomyces israelii. The patient underwent a second laparotomy was treated with erythromycin p.o. (later suspended) and one year later still had slight pain in the subumbilical region without hyperleukocytosis. It is suggested that women who have IUDs would benefit from systematic testing for Actinomyces during cervical examinations and if the results are positive the IUD should be removed to avoid severe infections.