SHM Converge Scientific Abstract ePoster Gallery-Who Knew H Flu Could Grow There? A Case of H. Influenza Tubo-Ovarian Abscess

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This case describes a 22-year-old woman with traumatic brain injury, hydrocephalus with a ventriculoperitoneal shunt, and borderline personality disorder who presented with three weeks of worsening left lower quadrant abdominal pain and new vaginal bleeding. She was afebrile and hemodynamically stable, with localized abdominal tenderness but no cervical motion tenderness. Labs showed a normal white blood cell count with neutrophilic predominance.<br /><br />CT abdomen/pelvis revealed a large rim-enhancing intra-abdominal fluid collection in the left lower quadrant near the sigmoid colon, along with coiling of the VP shunt tubing. Because the differential included intra-abdominal abscess, pelvic inflammatory disease, and tubo-ovarian abscess (TOA), general surgery, gynecology, and interventional radiology were consulted. The patient also reported high-risk sexual activity with multiple partners and inconsistent condom use.<br /><br />She was started on cefoxitin and doxycycline for presumed PID/TOA and underwent drainage of the collection. Culture of the fluid unexpectedly grew beta-lactamase-negative Haemophilus influenzae. She improved clinically and was discharged to complete a 14-day course of doxycycline and metronidazole.<br /><br />The case highlights that although PID and TOA are usually caused by sexually transmitted pathogens or typical genital tract flora, H. influenzae can also be a causative organism. While H. influenzae is best known as a respiratory pathogen, it can cause invasive extrapulmonary infections, including TOA, cholecystitis, and meningitis. Clinicians should consider this organism when evaluating PID/TOA, especially if patients do not respond as expected to standard therapy.

Asset Subtitle

Ellen Bouazizi

Meta Tag

Author List Ellen Bouazizi, Justine Nasr

Category Clinical Vignettes

Concept Tubo-Ovarian Abscess

Concept Pelvic Inflammatory Disease

Concept Haemophilus influenzae

Concept Extrapulmonary Infection

Concept Empiric antibiotic

Distinguished Non-Finalist

Presenter Organization Corewell Health William Beaumont University Hospital

Presenting Author Ellen Bouazizi

Track Adult

Keywords

traumatic brain injury

hydrocephalus

ventriculoperitoneal shunt

abdominal pain

vaginal bleeding

pelvic inflammatory disease

tubo-ovarian abscess

Haemophilus influenzae

intra-abdominal abscess

doxycycline

Tubo-Ovarian Abscess

Pelvic Inflammatory Disease

Haemophilus influenzae

Extrapulmonary Infection

Empiric antibiotic