Group A streptococcal salpingitis in a prepubertal girl

Spontaneous Streptococcus pyogenes pelvic inflammatory disease; Case report and review of the literature

Streptococcus pyogenes gynecological infections generally occur in association with childbirth, intra-uterine devices, and other invasive gynecologic procedures, but rarely cause spontaneous pelvic inflammatory disease. We describe a case of a healthy young woman with spontaneous S. pyogenes pelvic inflammatory disease, bacteremia, and shock, and summarize an additional 13 cases found in the literature. The majority were bacteremic and a significant number were also hypotensive. The same proportion had presenting gastrointestinal symptoms as had genitourinary symptoms, masking the diagnosis in many. Many prior case reports postulate a connection with S. pyogenes pharyngitis in a close contact, and an oro-genital route of transmission has been proposed given the exceedingly low rates of genital colonization with S. pyogenes. A high index of suspicion is needed for an accurate and timely diagnosis of this rare but potentially fatal condition.

Bilateral recurrent pyosalpinx in a sexually inactive 12-year-old girl secondary to rare variant of Mullerian duct anomaly

Pyosalpinx is a severe sequel of chronic pelvic inflammatory disease, whereby the fallopian tubes become filled with pus.1 2 Pyosalpinx often affects sexually active women and rarely is seen in celibate adolescent girls.3 We report a case of a 12-year-old girl with no prior sexual history who presented to our emergency department with complaints of severe right lower quadrant pain of 1-day duration. Ultrasonography and CT scan of the abdomen and pelvis revealed free fluid collections in the pelvis without visualisation of the appendix. A preoperative diagnosis of acute ruptured appendicitis was given and she was taken to the operating room. Peroperative findings included bilaterally distended, pus-filled pyosalpinges. A definitive diagnosis of bilateral pyosalpinx was then made. Two-week antibiotic therapy was successful but the patient returned with recurrent pyosalpinx and a pelvic abscess 9 weeks later.

Acute Salpingitis in a Nonsexually Active Adolescent

Acute salpingitis is an uncommon cause of an acute surgical abdomen, especially in an adolescent who is not sexually active. The following is a case of a 12-year-old girl who denied sexual activity, had a remote history of an appendectomy, and a recent diagnosis of a large, right-sided ovarian cyst, who presented with acute abdominal pain, urinary symptoms, and fever. The patient was ill-appearing and progressed to uncompensated septic shock in the emergency department despite aggressive fluid resuscitation and empiric antibiotics. She ultimately underwent an exploratory laparotomy and was diagnosed with acute bilateral salpingitis. This case highlights the diagnostic dilemmas facing those caring for an adolescent girl with abdominal pain and presents an extremely rare etiology for abdominal pain in a nonsexually active adolescent.

Pelvic inflammatory disease in virginal adolescent females without tubo-ovarian abscess

Pelvic inflammatory disease (PID) is an infection of the upper genital tract that is often caused by an ascending sexually transmitted infection. The complications of PID include pyosalpinx and tubo-ovarian abscess, infertility or ectopic pregnancy, and chronic pelvic pain of varying degrees. These sequelae underscore the importance of prompt diagnosis. We present 2 cases of PID in young women who denied any history of sexual activity or sexual abuse. Both cases were brought to the operating room with suspected appendicitis; however, laparoscopic evaluation revealed purulent fluid surrounding the pelvic organs. The literature is scant with respect to PID in the virginal patient. It is important to keep pelvic infection in the differential diagnosis of virginal patients who present with clinical symptoms of an acute abdomen.

Salpingitis. A rare cause of acute abdomen in a sexually inactive girl: a case report

Salpingitis is an acute inflammation of the fallopian tubes, most commonly caused by sexually transmitted micro-organisms in adolescent and adult women. It is rarely found in sexually inactive girls and generally the result of a blood-borne or genitourinary infection. In young girls without a history of consensual sexual contact, the possibility of sexual abuse should be considered.

Salpingitis usually presents as an acute abdomen. Appendicitis presents with almost the same symptoms as salpingitis. The diagnosis of salpingitis is often delayed until the presumed appendicitis is surgically explored.

We describe an 11-year-old girl with salpingitis caused by Streptococcus pneumoniae.

Paratubal and tubal abnormalities

The fallopian tubes are the essential genital ducts that convey the female sex cells for fertilization. They are differentiated and detectable early in fetal life. There are numerous paratubal and tubal abnormalities that can occur at any point in the female life. Some of these are rare but may initiate significant morbidity and/or manifest as life-threatening clinical problems. A comprehensive understanding of symptoms, diagnosis, optimal imaging modalities, and medical and surgical management is vital to identify the best treatment option. The clinical entities described in this article include torsion, hydatids of Morgagni, paraovarian cysts, infections including tuboovarian abscess/pyosalpinx and salpingitis isthmic nodosa, ectopic pregnancy, tumors, and genetic disorders.

Beta hemolytic streptococcus group f causing pelvic inflammatory disease in a 14-year-old girl

BACKGROUND

Pelvic inflammatory disease in prepubertal and non-sexually active adolescents is rare and poorly understood. Various organisms have been named as causative agents in adolescent pelvic infections. Early diagnosis and treatment of pelvic inflammatory disease in young girls is imperative to future fertility and long term sequela.

CASE

We present a 14-year-old, menarchal, non-sexually active female with a 3-week history of abdominal pain and fever. Surgical exploration and cultures revealed Stage IV pelvic inflammatory disease caused by Beta Streptococcus Group F.

CONCLUSION

Various organisms including Streptococcal infections should be considered in the differential diagnosis of pelvic inflammatory disease in young girls without risk factors.