SHM Converge Scientific Abstract ePoster Gallery-Toxic Shock-Like Syndrome and Tubo-Ovarian Abscess Following Endometrial Biopsy With Retained Tampon

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A 39-year-old woman with multiple sclerosis and tobacco use developed severe abdominal pain, intermittent fever, and septic shock four days after evaluation for abnormal uterine bleeding and vaginal odor, during which a retained tampon was found and a wet prep, endometrial biopsy, and cervical biopsy were performed. Shortly after the procedure she developed pelvic cramping and was started on metronidazole for clue cells on wet prep.<br /><br />On admission, she had bandemia, acute kidney injury, and lactic acidosis, raising concern for toxic shock-like physiology. She was treated immediately with broad-spectrum antibiotics including clindamycin, given the possibility of invasive group A streptococcal (GAS) infection. Blood and vaginal cultures later grew GAS. Initial CT imaging showed nonspecific colonic inflammation and a complex hypoechoic ovarian cyst, but she continued to worsen clinically with persistent abdominal pain, leukocytosis, and thrombocytopenia. MRI and PET imaging then demonstrated findings consistent with a tubo-ovarian abscess (TOA). Interventional radiology performed percutaneous drainage, after which she improved and was discharged on an extended antibiotic course.<br /><br />The case highlights that rare but life-threatening complications can follow office-based gynecologic procedures, including invasive GAS infection, toxic shock syndrome, and TOA. Retained tampons may serve as a nidus for colonization and subsequent infection. Clinicians should maintain a high index of suspicion for GAS/TSS in patients presenting with fever or severe abdominal pain after gynecologic procedures, and early aggressive therapy with toxin-suppressing antibiotics and prompt source control, including drainage of abscesses, may be lifesaving.

Asset Subtitle

Holly Crellin

Meta Tag

Author List Darrell Edward Jones, Holly Crellin

Category Clinical Vignettes

Concept Group A Streptococcal Infection

Concept Toxic Shock Syndrome

Concept Septic Shock

Concept Tubo-Ovarian Abscess

Concept Broad-Spectrum Intravenous Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization Womack Army Medical Center

Presenting Author Holly Crellin

Track Adult

Keywords

group A streptococcal infection

toxic shock syndrome

tubo-ovarian abscess

retained tampon

gynecologic procedure complication

septic shock

pelvic infection

broad-spectrum antibiotics

clindamycin therapy

percutaneous drainage

Group A Streptococcal Infection

Toxic Shock Syndrome

Septic Shock

Tubo-Ovarian Abscess

Broad-Spectrum Intravenous Antibiotic Therapy