Hindawi Publishing Corporation Infectious Diseases in Obstetrics and Gynecology Volume 2006, Article ID 69020, Pages 1–2 DOI 10.1155/IDOG/2006/69020 Case Report Pelvic Actynomyces Infection: Report of Two Cases Occurred in the Hospital of San Jos e´ Sergio Urbina, Hernando Ruiz, and Soﬁa Parejas Department of Gynecology and Obstetrics, Hospital of San Jos´e, Bogota´, Colombia Received 27 April 2006; Accepted 5 June 2006 The actynomyces infection is a rare cause of chronic pelvic inﬂammation, which can be manifested in multiple ways. It is caused by the actynomyces bacteria, usually by the israelii type, which can be a part of the normal ﬂora of the genital tract in patients who use intrauterine device (IUD). There is a discussion about the importance of considering this infection disease as part of the diﬀerential diagnosis in patients using the IUD, with atypical manifestations and bizarre presentation of infections of the genital tract, severe pelvic adherent syndromes, tubo-ovarian complexes (abscesses) barely symptomatic, and in the case of intraoperatory suspicion of pelvic carcinomatosis among others. Copyright © 2006 Sergio Urbina et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Case 1 The patient is a 38-year old female. She was admitted to the service for a scheduled extraction of IUD by hysteroscopy. The patient was asymptomatic. She has had the IUD for 9 years. During the hysteroscopy, it was evidenced that the IUD was perforating the uterine wall at the level of the fundus. There was visualization of intestinal loops through the de- fect. The laparoscopic procedure was converted into a la- parotomy due to the ﬁnding of sealed pelvis. The follow- ing are the ﬁndings from the exploratory laparotomy: uter- ine perforation, right adnexal mass in plastron, left tubo- ovarian complex perforated comprising the bowel wall at the level of the sigmoid colon, and secondary peritonitis. Hys- terectomy and bilateral salpingo-oophorectomy were done. A Hartmann hemicolectomy plus drainage of the peritoni- tis and lavage of the peritoneal cavity were also done. The postoperative progress of the patient was adequate with ab- sence of inﬂammatory response signs. The patient was dis- charged home. The histopathological analysis of the speci- men showed infection by actynomyces comprising the uterus adnexal tissues and with severe inﬂammatory process of the uterine wall. Based on the results of the histopathol- ogy, the patient was readmitted to the service for intra- venous antibiotic therapy. She was given crystalline peni- cillin 1 000 000 IU per hour by continuous infusion for 15 days. Then, she was discharged home on amoxicillin 2 grams BID, PO for six months. The patient has been fol- lowed up in two occasions one month apart in the outpatient clinic. The physical examination was within normal limits and laboratory workup showed no ﬁndings of infection or sepsis. Case 2 The patient is a 23-year old female. She was admitted to the emergency room with a main complain of three-month abdominal-pelvic pain associated with the feeling of abdom- inal mass in some occasions, subjective fever (not assessed by thermometer) in multiple occasions, asthenia, adynamia, and weight loss. As a relevant past medical history, the pa- tient has been diagnosed with bilateral adnexal masses, which have been followed up with tumor marker studies that are negative until this date. The past surgical history is posi- tive for appendectomy and two c-sections. The contracep- tion method used by the patient for the last three years was the IUD. When the patient was admitted to the service she presented a severe abdominal pain. Physical examination re- vealed a right adnexal mass of approximated 6 centimeters in diameter that was bounded to the body of the uterus and was not painful at manipulation. There was also a left adnexal mass of approximated 10 centimeters of diameter which was painful at palpation. Based on the ﬁndings of suﬀering left adnexal mass, the patient was taken to an ex- ploratory laparotomy due to acute abdomen diagnosis. Intra- operative ﬁndings were the following: severe adhesion syn- drome with sealed pelvis, and 3 centimeter diameter cys- tic mass in the omentum with signs of ischemia. During