Actinomycosis pelvic abscess after in vitro fertilization

Capsule:
A case of pelvic actinomycosis complicated by bilateral tuboovarian abscesses after assisted reproduction was treated with intravenous antibiotics and computed tomography-guided drainage of the pelvic abscesses, resulting in full recovery.

Authors:
Obehi A. Asemota, M.D., Eugenia Girda, M.D., Omar Dueñas, M.D., Genevieve Neal-Perry, M.D., Ph.D., Staci E. Pollack, M.D.

Volume 100, Issue 2, Pages 408-411, August 2013

Abstract:

Objective:
To report a case of pelvic actinomycosis presenting as large, multiloculated abscesses after an in vitro fertilization (IVF) cycle for male factor infertility.

Design:
A case report and literature review.

Setting:
University hospital.

Patient(s):
A 31-year-old nulligravid woman presenting with urinary retention, pelvic pain, and fever 6 days after transvaginal oocyte retrieval and an embryo transfer for male factor infertility.

Intervention(s):
Intravenous and oral antimicrobial therapy, and computed tomography (CT)-guided drainage of pelvic abscesses.

Main Outcome Measure(s):
Clinical and radiologic resolution of symptoms and infection.

Result(s):
The CT scan revealed several large, multiloculated pelvic and tuboovarian abscesses. The patient defervesced after 6 days of intravenous antibiotics, but the pelvic pain did not improve. After CT-guided drainage of the pelvic abscesses, the patient’s symptoms improved. The drained material was cultured, and the patient was diagnosed with pelvic actinomycosis tuboovarian abscesses, an infrequent cause of tuboovarian abscess and a rare complication of assisted reproductive technology (ART). The patient was switched from intravenous to oral antibiotics and discharged home.

Conclusion(s):
Pelvic Actinomyces israelii presenting as pelvic abscesses may occur as a rare complication of ART. Physicians should consider a diagnosis of tuboovarian abscess in a patient reporting fever and pelvic pain after IVF and embryo transfer.

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