A Massive Primary Ovarian Abscess within an Endometrioma in a Young Nullipara – An Unusual Case and Review of Literature

Primary ovarian abscess without the involvement of the fallopian tube is a rare complication of an underlying endometrioma. Surgical interventions like ultrasound guided oocyte retrieval in in vitro fertilization and endometrioma aspiration may be a possible source of infection. De novo primary ovarian abscess within an endometrioma in the absence of a risk factor is even rarer. Decreased natural killer cell activity leads to a failure to clear out the ectopic endometrial tissue and the collected blood acts as a potential culture medium for the growth of pathogenic microorganisms. Infected ovarian endometrioma is a surgical emergency and preserving the fertility in a nullipara is a challenge. We report an unusual case of a massive de novo ovarian abscess masking an endometrioma in a young nulliparous woman with no risk factors. We have summarized current literature and evaluated the etiopathogenesis and the risk factors leading to abscess formation within an endometrioma.