Aims: To report on a case of pelvic actinomycosis in a patient who has never used an intrauterine device. Background: A rare but serious infection, pelvic actinomycosis, is caused by Actinomyces species and has been found in 8–20% of women with intrauterine devices (IUDs). While the majority remain asymptomatic, up to 25% develop symptoms of pelvic infection. However, it can also occur in women without IUD. Case description: A 52-year-old multiparous woman with a history of vaginal hysterectomy 12 years earlier for abnormal uterine bleeding, following unsuccessful medical treatments, presented with complaints of white vaginal discharge, back pain and vaginal bleeding clinical examination revealed possible stump site bleeding with no mass palpable. Ultrasonogram (USG) abdomen and pelvis and contrast-enhanced computed tomography (CECT) abdomen and pelvis suggestive of left tubo-ovarian mass and right hydrosalpinx. The patient underwent a diagnostic laparoscopy followed by a bilateral salpingo-oopherectomy. Histopathology revealed findings consistent with tubo-ovarian actinomycosis. Conclusion: The prognosis for pelvic actinomycosis is generally favorable when treated promptly and appropriately. However, delays in diagnosis and treatment can result in significant morbidity due to extensive tissue involvement and complications such as abscesses and fistulae. Clinical significance: Despite its rarity, pelvic actinomycosis is a serious condition requiring keen diagnostic suspicion. With proper antibiotic treatment, most patients recover fully, although surgical intervention may be necessary in advanced cases.