Gonococcal Pelvic Inflammatory Disease with Sepsis Criteria: Review of 2 Cases

Sonia De-Miguel-Manso
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Abstract

Background: Infection caused by Neisseria Gonorrhoeae increases the risk of pelvic inflammatory disease (PID). Gonococcal PID tends to be clinically more severe than non-gonococcal ones. The main is to present two cases of gonococcal PID, with rapid clinical and analytic progression, leading to severe sepsis, but without imaging manifestations. Clinical presentation: 1. 41-year-old patient with replacement of intrauterine releasing levonorgestrel device (IUD), presented abdominal pain and green vaginal discharge. Abdominal examination revealed signs of peritoneal irritation and blood test showed leukocytosis, increased C Reactive Protein and procalcitonin, as well as coagulation abnormalities. Imaging tests (vaginal ultrasound/tomography) revealed no structural pathology, without collections. Given the criteria of severe sepsis, broadspectrum intravenous (iv) antibiotic therapy was started and laparoscopy and IUD removal were performed. Cervical and IUD cultures were positive for Neisseria gonorrhoeae. 2. 20-year-old woman, with an IUD, consulted for abdominal pain, low-grade fever and green vaginal discharge. Abdominal examination suggested peritoneal sensitivity and laboratory tests leukocytosis, increased C Reactive Protein and procalcitonin with coagulation abnormalities. Imaging tests (vaginal ultrasound/tomography) showed no structural pathology, without collections. Despite analgesia and broad-spectrum iv antibiotics, the patient worsened, proceeding to remove the IUD. Given the criteria compatible with severe sepsis, laparoscopy was decided. Endocervical and IUD cultures revealed Neisseria gonorrhoeae. Conclusions: Facing the situation of an acute PID with severe and fast clinical worsening even without findings in imaging tests, we should consider gonococcal ethiology as a possible cause. Surgical approach shouldn’t be delayed in order to control the infection and rule out other possible diagnosis.
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淋球菌性盆腔炎伴败血症标准:2例回顾
背景:淋病奈瑟菌引起的感染会增加盆腔炎(PID)的风险。淋球菌性PID在临床上往往比非淋球菌性更严重。主要是两例淋球菌性PID,临床和分析进展迅速,导致严重败血症,但没有影像学表现。临床表现:1。41岁的患者更换了宫内释放的左炔诺孕酮装置(IUD),出现腹痛和绿色阴道分泌物。腹部检查显示腹膜刺激迹象,血液检查显示白细胞增多,C反应蛋白和降钙素原增加,以及凝血异常。影像学检查(阴道超声/断层扫描)显示无结构性病理,无采集。考虑到严重败血症的标准,开始了广谱静脉(iv)抗生素治疗,并进行了腹腔镜检查和宫内节育器摘除。宫颈和宫内节育器培养物对淋球菌呈阳性反应。2.20岁女性,带宫内节育器,因腹痛、低热和绿色阴道分泌物就诊。腹部检查显示腹膜敏感性,实验室检查显示白细胞增多,C反应蛋白和降钙素原增加,伴有凝血异常。影像学检查(阴道超声/断层扫描)显示无结构性病理,无采集。尽管有镇痛和广谱静脉注射抗生素,患者病情恶化,继续摘除宫内节育器。考虑到与严重败血症兼容的标准,决定进行腹腔镜检查。宫颈内和宫内节育器培养显示淋球菌。结论:面对急性PID的情况,即使在影像学检查中没有发现,临床也会严重而快速地恶化,我们应该将淋球菌流行病学视为可能的原因。不应该为了控制感染和排除其他可能的诊断而推迟手术方法。
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