Case Report of Invasive Salmonella Superinfection of an Ovarian Endometrioma in a Patient With Systemic Lupus Erythematosus

Abstract

Objective: To present a case of invasive salmonella superinfection of an ovarian endometrioma in a patient with systemic lupus erythematosus, most likely due to exacerbation of a prior infection due to immunocompromised status, and review of literature on the typical and atypical manifestation of salmonella infection. Design: Case report and mini-review. We used the CARE checklist when writing our report. Materials and methods: For diagnosis of Salmonella bacteremia, cultures were used. Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) was used to further diagnose the patient with Salmonella enterica ssp. diarizonae. Setting: University-based OBGYN service. Patient: A 40-year-old G3P3003 female, initially presenting with nausea, non-bloody emesis, watery diarrhea, subjective fevers, and extreme fatigue, was found to have positive cultures for salmonella infection. Cefepime was administered with subsequent marked improvement in symptoms. Patient represented 2 months later with abdominal pain and fever and was confirmed to have a salmonella-infected endometrioma. Intervention: Explorative laparotomy, right salpingo-oophorectomy, and left adnexal cyst drainage. Main outcome: Outcome and complication of surgical management of salmonella superinfection of an ovarian endometrioma. Result: Post-op, the patient experienced post-op fevers until POD7, when her symptoms began to improve significantly. Persistent fevers were attributed to surgical complications involving a cyst rupture during removal. The patient was subsequently discharged with a 6-week course of Ciprofloxacin 500 mg BID and suppressive amoxicillin PO 500 mg BID after completing the Ciprofloxacin regimen due to immunocompromised status. Conclusion: Assessment for metastasis to other organs is crucial in evaluating immunocompromised patients diagnosed with salmonella infections. Surgical management should be highly considered.