Case report of tubo-ovarian abscess due to Actinomyces israeli is presented with revision of the literature with regard to pathogenesis, diagnostic difficulties and treatment. Diagnosis was established by culturing the organism from exudate obtained during surgery. The pathogenesis of pelvic actinomycosis is still controversial. Penetration of the GI tract with subsequent infection of the pelvic viscera seems to be the most likely mode of infection. Penicillin has an important role in the treatment of this disease. It does not cure, but retards the course of the infection. Surgical extirpation of infected tissue in combination with penicillin offers the best therapeutic results. When chronic pelvic inflammatory disease does not respond to therapy, when the sedimentation rate remains high, and the patient's general debility is progressive, an actinomycotic infection should be suspected.