Salmonella-induced ovarian abscess developing in bilateral ovarian endometriomas: A case report

Salmonella species are common causes of foodborne illnesses, typically resulting in self-limiting gastroenteritis. In rare cases, however, they can cause extraintestinal infections, including pelvic infections. This report concerns a rare case of Salmonella infection of bilateral ovarian endometriomas. A 29-year-old nulligravid woman with known bilateral ovarian endometriomas presented with persistent fever and lower abdominal pain, following symptoms of diarrhea. Computed tomography on admission showed moderate ascites and increased density of mesenteric fat, suggestive of peritonitis. Her symptoms and inflammatory markers persisted, despite 5 days of empirical antibiotic therapy for pelvic inflammatory disease (intravenous ceftriaxone 1 g/day, clindamycin 2400 mg/day, and oral doxycycline 200 mg/day). Repeat computed tomography showed worsening peritonitis and a new right-sided pleural effusion, prompting surgical intervention. Laparotomy revealed purulent material within both endometriomas and cultures confirmed Salmonella infection. Detailed history-taking indicated that the patient had ingested raw eggs before symptom onset. The patient made a full recovery after surgery and tailored antibiotic therapy adjusted according to the susceptibility. This case highlights the importance of considering Salmonella as a rare cause of tubo-ovarian abscess, especially in patients with a history of dietary exposure and pre-existing endometriomas. Prompt surgical drainage and appropriate antibiotic therapy are key to preventing complications and preserving fertility.