Supplementary Material for: Disseminated Actinomyces Case Report: A mimicker of advanced ovarian malignancy

Introduction
Disseminated actinomyces is a rare infection that presents with subtle symptoms and radiographic findings. Patients frequently complain of pelvic pain and non-specific gastrointestinal symptoms. Imaging can reveal a tumor like mass and mimic malignancy. Here we discuss a patient who presented with abdominal pain and CT imaging revealed a pelvic mass and carcinomatosis concerning for ovarian cancer.

Case Presentation
A 55-year-old woman presented with one week of abdominal pain and 5 months of increasing abdominal girth. CT imaging was concerning for an advanced ovarian cancer and demonstrated a pelvic mass, peritoneal nodularity and omental thickening. She subsequently underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and abdominal wash-out with pathology and cultures revealing disseminated actinomyces. She fully recovered after receiving a long course of antibiotics.

Conclusion
This case adds to the limited literature illustrating that disseminated actinomyces can present similarly to ovarian cancer. The diagnosis may only be elucidated upon histologic examination of surgical specimens. Consideration of pelvic actinomyces should be entertained in all women presenting with pelvic tumors on imaging and intrauterine devices in place.

引言
播散性放线菌感染（Disseminated actinomyces）是一种罕见感染，其临床症状与影像学特征均较为隐匿。患者常主诉盆腔疼痛与非特异性胃肠道症状。影像学检查可表现为类肿瘤样肿块，易与恶性肿瘤混淆。本文报告一例以腹痛为首发症状的患者，其CT（Computed Tomography）检查提示盆腔肿块伴腹膜癌病，高度怀疑卵巢癌。

病例介绍
一名55岁女性因腹痛1周、腹围进行性增大5个月就诊。CT检查提示为晚期卵巢癌，可见盆腔肿块、腹膜结节及网膜增厚。患者随后接受了全子宫切除术+双侧输卵管卵巢切除术及腹腔冲洗术，术后病理及微生物培养结果证实为播散性放线菌感染。患者经长期抗生素治疗后完全康复。

结论
本病例补充了有限的相关文献，表明播散性放线菌感染的临床表现可与卵巢癌高度相似。该病的确诊往往需依赖手术标本的组织病理学检查。对于影像学提示盆腔肿瘤且宫内放置节育器的女性，应考虑盆腔放线菌感染的可能。