Complex clinical management of group A Streptococcal pelvic inflammatory disease after bilateral tubal ligation in a small community hospital

BMJ Case Rep. 2020 Oct 27;13(10):e236326. doi: 10.1136/bcr-2020-236326.


A 43-year-old woman with a history of bilateral tubal ligation and bilateral ovarian cysts presented to our hospital with progressively worsening right lower quadrant pain and abdominal distension. Her exam findings of vaginal discharge and cervical motion tenderness, in combination with her marked leucocytosis, were suggestive of pelvic inflammatory disease (PID). PCR for Chlamydia trachomatis and Neisseria gonorrhoeae was negative, however, our patient's blood cultures grew group A Streptococcus This exceptionally severe presentation of PID, in combination with uncommon laboratory findings, led to complex multidisciplinary clinical decision making guided by extensive literature review. Here, we present a rare case of group A Streptococcus PID after bilateral tubal ligation, and highlight the role of a family medicine primary team in the medical and surgical management of a complex case at a community hospital.

Keywords: general practice / family medicine; obstetrics and gynaecology; pelvic inflammatory disease.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Clinical Decision-Making*
  • Disease Management*
  • Female
  • Hospitals, Community
  • Humans
  • Pelvic Inflammatory Disease / diagnosis
  • Pelvic Inflammatory Disease / therapy*
  • Sterilization, Tubal / adverse effects*
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / therapy*
  • Streptococcus pyogenes / isolation & purification*
  • Tomography, X-Ray Computed