Pelvic actinomycosis presenting as a single episode of postmenopausal bleeding in a 60-year-old woman whose intrauterine contraceptive device had been removed 10 years previously: A case report

Actinomycosis is a rare opportunistic infection caused by Actinomyces bacteria entering tissue through a disruption in the normal mucosal barrier and spreading in a slow, progressive manner. Patients often present with mass lesions and abscesses which mimic malignancy. We present the case of a 60-year-old postmenopausal woman who presented with a single episode of spotting with no other symptoms. On hysteroscopic examination no abnormalities were found and Actinomyces spp. were cultured from an endometrial biopsy. The patient had last used an intrauterine contraceptive device (IUCD) 10 years previously; it had been removed at menopause. This is a rare presentation that highlights that pelvic actinomycosis can be precipitated by factors other than IUCD use. Biopsy is important, as ultrasound is not diagnostic.