ABSTRACT
BACKGROUND: Pelvic inflammatory disease (PID) is a difficult diagnosis. Five billion dollars is spent on over 1 million women diagnosed each year. Atypical organisms and prior history of tubal ligation may complicate the diagnosis. CASE: A woman who had undergone tubal ligation and abstained from intercourse for over two years developed group A streptococcal salpingitis. It occurred following an upper respiratory infection with the same organism. CONCLUSION: PID is rare in a woman with prior tubal ligation who is not engaging in intercourse. In this case it followed an upper respiratory infection with group A Streptococcus. Low diagnostic suspicion must be maintained for uncommon pathogens in PID in women with prior tubal ligation who are not engaging in intercourse.