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.