Images in infectious diseases in obstetrics and gynecology. Actinomyces pelvic infection.

Actinomyces israelii is an uncommon cause of upper genital tract infection. This gram-positive anaerobe is occasionally noted on the Papanicolau smear of asymptomatic patients utilizing the intrauterine device. In this case, a 57-year-old woman presented with postmenopausal vaginal bleeding. A Pap smear showed filamentous microorganisms consistent with Actinomyces israelii (A). Despite a negative history of IUD use, a pelvic ultrasound confirmed the presence of an IUD (B). Endometrial biopsy at the time of removal of the device (a Dalkon shield) (C), revealed evidence of plasma cell endometritis and sulfur granules consistent with actinomycosis (D). (C) 1998 Wiley-Liss, Inc.