－58－南予医誌 Vol.20 No. 1 2020 Pelvic actinomycosis is an infection caused by anaerobic Gram-positive bacilli in the Actinomyces group that progresses to a chronic suppurative granulomatous infection. Pelvic actinomycosis is often misidentified as a malignant tumor because it invades tissue destructively. We recently encountered a case of hydronephrosis due to a pelvic mass suspected to be afflicted with pelvic actinomycosis. The patient was 62 years old. She visited a nearby hospital with complaints of lower right abdominal pain and fever. A plain abdominal computed tomography （CT） scan revealed a mass in the right appendage area, ureteral dilation from the same site, and right hydronephrosis. She presented to our hospital for a suspected ureteral invasion of right ovarian cancer. She had an IUD that had been left unchecked for > 20 years. When she visited our hospital, transvaginal ultrasonography showed a 30-mm solid mass in the right adnexal area and the IUD in the uterus. Tenderness was noted at the same site, and a blood test revealed increased inammatory markers; thus, we suspected an appendage ame. Actinomycetes were detected on cervical cytology and a microscopic examination of the vaginal discharge. We treated the patient with ampicillin sodium （ABPC）. Clinical symptoms improved after the start of treatment, and blood ndings improved. We switched to oral administration of amoxicillin （AMPC） beginning on day 8 after starting treatment, and outpatient management was facilitated. The hydronephrosis was relieved with reduction of the adnexal mass. We treated the patient for 6 months, and she was asymptomatic at the follow-up visit.Department of Gynecology Uwajima City HospitalGoten-machi,Uwajima,Ehime,798-8510,JapanAbstractYoshiko AKI,Norihumi NAKAHASHI,Masaki KIYOMURA,Yuko AOISHI,Matome IMAI,Syota INOUEA case of hydronephrosis caused by an intrapelvic mass suspected of pelvic actinomycosisKey words：pharyngeal syphilis, lymphadenopathy, syphilis serum response
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