Actinomycosis involving the liver. Computed tomography/ultrasound correlation

The clinical profile of pelvic actinomycosis, which is being recognized with increased frequency in IUD users, can be misleading in such patients and lead to dangerous delays in diagnosis. The authors present a case in which an IUD user initially sought medical attention for multiple liver abscesses secondary to spread from unsuspected ovarian actinomycosis. The 43-year-old patient, who was admitted with right upper quadrant pain and fever, had a 15-year history of IUD use, although the device had been removed 1 year prior to admission for apparent infection in the left ovary. Ultrasound revealed mixed cystic and solid liver lesions as well as a complex subcapsular fluid collection. A solid left adnexal mass was demonstrated in the pelvis. Computed tomography scan indicated extension of 1 of the complex cystic liver lesions through the liver capsule and into the abdominal wall. Needle aspirations of the liver lesions yielded thick pus that was later identified as Actinomyces israelii. Actinomycosis was evident in the ovarian lesion. Colonization of the vagina and uterus by actinomycosis has been reported by 1.6-5.3% of IUD users, and the risk appears to increase when the same IUD is used for a prolonged time period. In this case, neither the computed tomography scan nor ultrasound suggested an inflammatory process of the left ovary. Aspiration of a liver lesion under ultrasound guidance was necessary for the correct diagnosis. Since actinomycosis has the potential to spread to extrapelvic organs such as the peritoneum, liver, and brain, early diagnosis is essential.