AN ACTINOMYCES ABSCESS FOLLOWING INTRAOVARIAN INJECTION OF PLATELET-RICH PLASMA (PRP): A CASE STUDY

Abstract

Introduction

The intraovarian injection of platelet-rich plasma (PRP) represents a novel approach with the potential to enhance folliculogenesis and elevate live birth rates in poor responders. Nevertheless, as with any interventional procedure, there is a possibility of adverse effects associated with the administration of PRP.

Case Report

A 22-year-old female patient, who had undergone intraovarian injection of PRP at another centre two weeks prior, was prescribed ciprofloxacin for the treatment of groin pain that developed one week following the procedure. The patient was admitted with a history of increasing groin pain, fever, and chills. Despite the stability of the vital signs, the patient exhibited tenderness in the lower quadrants of the abdomen. The laboratory findings indicated elevated levels of C-reactive protein (CRP), procalcitonin (PCT), and white blood cells (WBC). The computed tomography (CT) scan revealed the presence of a 7 cm tubo-ovarian abscess in the right sight. On the second day of hospitalization, the patient subsequently underwent abscess drainage in the interventional radiology department, and an abscess culture was obtained. The infectious diseases department recommended piperacillin-tazobactam 3*4.5 g IV. Subsequently, these treatments resulted in an improvement in the patient's condition and a reduction in acute-phase reactants (AFRs), with a decrease in CRP (308->92), PCT (1.8->0.69), and WBC (21.600->18.550). However, on the fifth day, the AFRs began to increase once more, piperacillin-tazobactam was discontinued following the identification of Actinomyces in the abscess culture, and ampicillin-sulbactam 4*1.5 g IV was initiated in conjunction with the gentamicin-clindamycin protocol. A clinical and laboratory evaluation conducted on the seventh day of hospitalization revealed no improvement. Following the detection of free fluid in the abdomen and persistent abscess sites via ultrasonography (Video 1), a decision was made to proceed with laparoscopic abscess drainage. An encapsulated abscess extending from the anterior surface of the uterus to the upper abdomen towards the spleen was cleaned with the contributions of the general surgery team, and a soft drain was placed laparoscopically (Figure 1). Following the procedure, a favorable response was observed in both the clinical condition and the AFR regression with the current antibiotic regimen. The patient was discharged on the 12th day with oral amoxicillin-clavulanate.

Conclusion

Despite the existence of ongoing randomized controlled trials evaluating the efficacy of PRP in women with poor responses, its clinical application remains considered experimental. The intraovarian injection of PRP, an invasive approach designed to enhance ovarian response, has been observed to manifest in rare instances as serious complications.