We report a case of hepatic actinomycosis in a 41-year old woman with an intrauterine device (IUD) in place that presented with abdominal pain and fever. After evaluation with transvaginal and abdominal ultrasound as well as computed tomography (CT) scan, a hepatic abscess was identified by MRI and actinomycosis infection was confirmed by visualization of yellow sulfur granules on pathologic evaluation of abscess aspirate. The patient was treated with 14 days of doxycycline and amoxicillin and she improved clinically. Actinomycosis has been increasingly associated with prolonged IUD usage but has proven to be extremely difficult to diagnose because of its rare occurrence and nonspecific symptoms.

Authors: Sarah Lumsden, Francis Gannon, Daniel Rosen

Key Words: Actinomycosis; hepatic actinomycosis; intrauterine device