Tubo Ovarian Abscess Caused by Streptococcus Group B: A Case Report and Literature Review

Abstract

A 34 year-old Thai female woman who had a previous history of recurrent pelvic inflammatory disease or recurrent pelvic inflammatory disease (PID), presented with recurrent pelvic pain and high grade fever. She was admitted and a diagnosis of tubo ovarian abscess was made. Physical examination and ultrasonographic examination demonstrated high grade fever, adnexal tenderness and a right mixed solid cystic mass compatible with tubo ovarian abscess. Despite prescription of combined parenteral antibiotic, her symptoms did not improve. An exploratory laparotomy showed a left ovarian abscess with a kinked fallopian tube behind the uterus. A left salpingectomy with partial oophorectomy was performed. Cultured pus was identified as group B streptococci. Antibiotics therapy was continued until clinical improvment and she was discharged on the seventh post operative day. Tubo ovarian abscess or tubo ovarian abscess (TOA) is a serious consequence of PID. The streptococcus group B infection is a rare cause of TOA. There is a discussion about diagnosis, medical treatment and surgical treatment. Although medical treatment with broad-spectrum antibiotics has allowed patients to avoid operations, some of them who failed medical treatment required surgical treatment. Especially in women who need childbearing potential in future, conservative surgery has become the initial approach as well as this case report.