Introduction: Ectopic pregnancy in the presence of an intrauterine device is a rare phenomenon. When compared with copper device, the levonorgestrel intrauterine system appears to be more protective against ectopic pregnancies. Few case reports have described ectopic pregnancies.

Case Report: A 39-year-old woman with a levonorgestrel-releasing intrauterine device presented at our emergency room complaining of persistent lower abdominal pain and scarce vaginal bleeding. Pelvic ultrasound revealed the intrauterine device properly positioned inside the uterine cavity and the presence of an anexial mass, raising the suspicion of ectopic pregnancy, later confirmed with beta-HCG blood level. She was successfully treated with laparoscopic salpingectomy.

Conclusion: An ectopic pregnancy with an in-situ levonorgestrel intrauterine device is a rare occurrence. Early diagnosis is of paramount importance in order to prevent its potential catastrophic consequences. Physicians prescribing this type of intrauterine device should be aware of the possibility of this rare event, as the symptoms produced by a tubal gestation may easily be mistaken for side effects due to the intrauterine device.

Keywords: Contraception, Ectopic pregnancy, Intrauterine Device, Levonorgestrel