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Case report
Complex clinical management of group A Streptococcal pelvic inflammatory disease after bilateral tubal ligation in a small community hospital
  1. Emily Wolfenden1,
  2. Maanvi Mittal2 and
  3. Rachel Sussman2
  1. 1College of Medicine, The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
  2. 2Department of Family Medicine, Stanford Health Care, San Jose, California, USA
  1. Correspondence to Dr Emily Wolfenden; emily.wolfenden{at}


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.

  • pelvic inflammatory disease
  • general practice / family medicine
  • obstetrics and gynaecology

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  • Contributors EW helped in drafting and editing entire contents and obtaining patient consent. MM helped in drafting discussion and editing entire contents. RS helped in drafting learning points and editing entire contents.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.