Open AccessComplex clinical management of group A Streptococcal pelvic inflammatory disease after bilateral tubal ligation in a small community hospital
Author(s) -
Emily Wolfenden,
Maanvi Mittal,
Rachel Sussman
Publication year - 2020
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2020-236326
Subject(s) - medicine , pelvic inflammatory disease , chlamydia trachomatis , tubal ligation , vaginal discharge , ligation , surgery , abdominal pain , general surgery , gynecology , family planning , population , environmental health , research methodology
A 43-year-old woman with a history of bilateral tubal ligation and bilateral ovarian cysts presented to our hospital with progressively worsening right lower quadrant pain and abdominal distension. Her exam findings of vaginal discharge and cervical motion tenderness, in combination with her marked leucocytosis, were suggestive of pelvic inflammatory disease (PID). PCR for Chlamydia trachomatis and Neisseria gonorrhoeae was negative, however, our patient's blood cultures grew group A Streptococcus This exceptionally severe presentation of PID, in combination with uncommon laboratory findings, led to complex multidisciplinary clinical decision making guided by extensive literature review. Here, we present a rare case of group A Streptococcus PID after bilateral tubal ligation, and highlight the role of a family medicine primary team in the medical and surgical management of a complex case at a community hospital.