Pelvic actinomycosis in the presence of an endocervical contraceptive device. Report of a case.

Abstract

A case report is presented of a patient in whom the longterm presence of a metallic foreign body in the cervix may have been relevant to the etiology of pelvic actinomycosis. A 50 year old married white female was hospitalized on March 17 1964 with a 3 week history of abdominal pain. There was no nausea vomiting or fever. The patient was a gravida 1 and para 1. She had noticed a whitish vaginal discharge for several weeks. A urector spiral type had been inserted in 1939 into the cervical os for contraceptive purposes. At operation the intestines the stomach liver and other organs were all normal and not attached to the pelvic process. There was an abscess of the right tube and ovary. The uterus was intimately involved and leiomyomata were noted. Hysterectomy and right salpingo-oophorectomy were performed. The pathology report indicated multiple leiomyomata of the uterus and endocervical ovarian and tubal actinomycosis with abscess formation. On the 8th postoperative day the pathology report was received and large doses of penicillin and sulfisoxazole began to be administered for an extended period. 1 week after the patients discharge on the 16th postoperative day she returned complaining of swollen glands in the neck and weakness. The hematocrit white blood count and differential were normal but the erythrocyte sedimentation rate was 40 mm/hour. Urinalysis showed innumerable white blood cells but culture of the urine was again negative. On the 9th hospital day of the 2nd admission she developed a white coating on her tongue which was found to be due to monilia and she was given oral mycostatin. The patient was discharged on April 23 1965 afebrile and feeling well. She was followed for the next 8 months during which time she had intermittent difficulties with abdominal pain vaginitis and hot flashes. Medications were discontinued in October 1964. The metal endocervical device or uterector inserted and not removed for 25 years may have been the source of an ascending infection from its position in the cervix. The device however was not cultured but discarded. The cervical mucosa under it was eroded but was the site of a chronic inflammatory process reported as actinomycosis. This conforms to the theory that actinomycosis does not spread through normal tissues unless there has been a break in the mucosa membranes.