Ovarian actinomycosis: A vicious mimicker of a malignancy in a nonintrauterine device user

Actinomyces is a Gram-positive, branching filamentous bacteria. It is a usual commensal of the oral cavity, distal esophagus, tonsillar crypts, and genitourinary system. The most common sites of actinomycosis are cervicofacial, thoracic, and intestinal actinomycosis. We report an unusual presentation of actinomycosis presenting as an ovarian mass. The patient was a 54-year-old female with a history of total abdominal hysterectomy 15 years back for a fibroid uterus who presented with pain abdomen, loss of appetite, and weight loss for 3 months. The patient was a known diabetic on treatment for 20 years. Radiologically, it was thought to be a solid cystic tumor, but intraoperatively, the patient was found to have a left ovarian cyst. Laparoscopic oophorectomy was performed and histopathology revealed an actinomycotic cyst. Ovarian actinomycosis is rare and is generally known in intrauterine device (IUD) users. In this case, there was no history of IUD usage. It is important for the clinician and the pathologist to consider a possibility of an infectious etiology when faced with a unilateral ovarian cystic mass in addition to considering a malignancy.