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Actinomycosis affecting the fallopian tube and ovary: report of 3 cases, with special reference to 2 cases following IUD application.


 Since the late 1970s, pelvic actinomycosis in association with IUD use has been a not infrequent complication in the US and Europe. In contrast, only 3 cases of pelvic actinomycosis have been reported from Taiwan over the past 40 years. IUD use was present in 2 of these cases (for 13 months and 5 years, respectively); the 3rd patient had never been an IUD user. These 3 cases were detected by sulfur granules and histology. Pathologic signs included pymetra containing pus with sulfur granules, branching of actinomyces, chronic inflammation of the bilateral fallopian tubes and ovaries, liquefaction necrosis, and tubo-ovarian abscesses. Penicillin and tetracycline were administered; the postoperative course was uneventful. The longterm presence of an IUD is believed to facilitate actinomycosis given the preexistence of other anaerobic infection or endometrial injury. In the 1 Taiwanese case where there was a history of IUD use, infection may have penetrated from the anorectum; in the 2nd such case, the intestinal route seemed likely. The low incidence of pelvic actinomycosis in Taiwan occurs against a backdrop of widespread IUD use (136,200 IUD insertions in Taiwan Province in 1986). It remains unclear whether the rarity of pelvic actinomycosis in this setting reflects underdiagnosis, life style factors, or racial differences in sexual behavior.
