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We presented a case of tubo-ovarian actinomycosis in a patient with an intrauterine device (IUD). The patient was referred to our clinic with a diagnosis of pelvic inflammatory disease. Magnetic resonance imaging analysis indicated a cystic lesion (6.6x8x8 cm) on the left over. After performing total abdominal hysterectomy and bilateral salpingo-oopherectomy, histopathological studies showed a tubo-ovarian abscess and typical sulphur granules surrounded by neutrophils associated with actinomycosis. This case indicated that if clinicians are aware of actinomycosis in patients using IUCDs, the formation of tubo-ovarian abscess and thus excessive surgical procedures can be prevented.