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BMJ Case Rep ; 14(7)2021 Jul 27.
Article in English | MEDLINE | ID: mdl-34315737

ABSTRACT

A 22-year-old woman presented to the emergency room with right lower abdominal pain. A CT scan suggested potential appendicitis and perforation. She had no relevant medical or surgical history, and she last had vaginal sex 4 years prior to admission. During surgery, turbid fluid, secondary inflammatory changes, and dilated, fluid-filled fallopian tubes pointed to a diagnosis of pelvic inflammatory disease (PID), so she was started on azithromycin, metronidazole and piperacillin/tazobactam. The following day, she continued to have abdominal pain and developed tachycardia, hypotension, a marked leukemoid response, haemoconcentration, third space fluid accumulation and acidosis. Culture results led to her being further diagnosed with Clostridium perfringens PID with peritonitis and toxic shock syndrome. A gynaecological infection of C. perfringens leading to toxic shock syndrome is both extremely rare and highly fatal. Her antibiotics were changed to meropenem and clindamycin, and she slowly made a full recovery.


Subject(s)
Appendicitis , Pelvic Inflammatory Disease , Peritonitis , Shock, Septic , Adult , Clostridium perfringens , Female , Humans , Pelvic Inflammatory Disease/complications , Pelvic Inflammatory Disease/diagnosis , Pelvic Inflammatory Disease/drug therapy , Shock, Septic/etiology , Young Adult
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