Bilateral tubo-ovarian abscess and sepsis caused by Salmonella in patients with systemic lupus erythematosus.

To cite: Guler S, Oksuz H, Cetin GY, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013200187 DESCRIPTION A 39-year-old woman was admitted to the emergency department due to abdominal pain. Her history included systemic lupus erythematosus (SLE) and use of immunosuppressive drugs. The patient’s general condition was poor with fever and tenderness in the abdomen. Laboratory tests revealed leukopenia (3800/mm), elevated C reactive protein (112 mg/dL) and international noramalised ratio (INR 11). In contrast-enhanced CT, bilateral tubo-ovarian abscess was observed sized 86×44 and 95×88 mm (figures 1 and 2). The patient was operated after INR level normalised by fresh frozen plasma. She was started on intravenous imipenem/cilastatin therapy empirically. Salmonella spp. was isolated from the blood specimen and abscess material. Salmonella spp. are susceptible to cefepime, ceftazidime trimethoprim–sulfamethoxazole, piperacillin–tazobactam, tigecycline and colistin. But the patient’s general condition did not improved, and she died on the fourth day of hospitalisation despite proper treatment. Non-typhoidal salmonellosis is a food-borne infection that occurs in patients throughout the world, especially in immunocompromised patients. The common risk factors include old age, malignancy, diabetes, rheumatological disorders, immunosuppressive therapy and HIV. Patients with SLE are predisposed to non-typhoidal Salmonella infection with high incidence of bacteraemia and abscess formation. Infection-related mortality rate in patients with connective tissue diseases (CTDs) was 2.1–79%. The rate of infection-related mortality in SLE is higher than other CTDs, although 83% of these patients receiving appropriate antimicrobial agent within 72 h. 3 Ruptured ovarian cysts, adnexal mass, chronic ectopic pregnancy and malignancy should be considered in the differential diagnosis of tubo-ovarian abscess.