ARDS and systemic sepsis from Actinomycosis related IUCD infection

Abstract

Six weeks following a reinsertion of a levonorgestrel intrauterine device, this 43 year old lady was admitted with severe abdominal pain. Radiological investigations indicated fluid collection in the rectovaginal area. The differential diagnosis included pelvic inflammatory disease with a possible pyosalpinx. The condition of the patient deteriorated with the patient developing pleural effusions and other pulmonary complications and adult respiratory distress syndrome, despite treatment with antibiotics directed for systemic sepsis. Patient started improving after CT guided aspiration of the pelvic abscess. Further management with antibiotics was administered after blood cultures showed an Actinomycosis infection. This patient presenting with a non-pulmonary cause of sepsis deteriorated rapidly and developed Adult Respiratory Distress syndrome. Although Actinomycosis is detected incidentally on cervical cytology in asymptomatic patients with an intrauterine device, it may present with tiredness, pyrexia and rigors. Removal of intrauterine device should be carried out after a course of antibiotics and followed by an interval of six weeks before reinsertion.