SHM Converge Scientific Abstract ePoster Gallery-Trichomonas Vaginalis Associated Septic Shock in a Hiv-Negative Immunocompetent Patient

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This case report describes a 26-year-old HIV-negative, immunocompetent woman who presented obtunded with severe septic shock, hyperthermia, and tachycardia. She required intubation, vasopressors, and broad-spectrum antibiotics. Early cultures were negative, and she later developed disseminated intravascular coagulation with bleeding, petechiae, thrombocytopenia, and low fibrinogen.

On hospital day 4, clinicians noted foul-smelling purulent vaginal discharge. Wet mount microscopy identified <em>Trichomonas vaginalis</em>, while nucleic acid/amplification testing for <em>Chlamydia trachomatis</em>, <em>Neisseria gonorrhoeae</em>, and <em>Mycoplasma genitalium</em> was negative. CT imaging showed intraperitoneal free fluid and intrauterine free air, supporting a pelvic/intrauterine infectious source. Her antibiotics were changed to doxycycline, metronidazole, and cefepime, with prompt clinical improvement.

The report emphasizes that pelvic inflammatory disease is usually caused by <em>C. trachomatis</em>, <em>N. gonorrhoeae</em>, and <em>M. genitalium</em>, but <em>T. vaginalis</em> can also be involved, especially in patients with HIV. However, this case demonstrates that <em>T. vaginalis</em> can be associated with severe PID and septic shock even in HIV-negative, immunocompetent patients.

The authors discuss possible mechanisms for ascending infection, including disruption of the cervical mucus plug and punctate hemorrhage that allows organisms to invade endometrial tissue. They also note that negative testing for common PID pathogens does not completely exclude ascending infection.

Overall, the case highlights the need for a broad differential diagnosis in septic patients with unclear sources and underscores the importance of prompt gynecologic evaluation, imaging, and interdisciplinary care.

Asset Subtitle

Eric Chan

Meta Tag

Author List Ashok Biju, Bryce Meck, Eric Chan, Roudi Bachar

Category Clinical Vignettes

Concept Pelvic Inflammatory Disease

Concept Sepsis

Concept Septic Shock

Concept Trichomonas vaginalis

Concept Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization Indiana University

Presenting Author Eric Chan

Track Adult

Keywords

Trichomonas vaginalis

pelvic inflammatory disease

septic shock

immunocompetent

HIV-negative

disseminated intravascular coagulation

purulent vaginal discharge

ascending infection

intrauterine free air

gynecologic evaluation

Pelvic Inflammatory Disease

Sepsis

Septic Shock

Trichomonas vaginalis

Antibiotic Therapy