An unusual presentation of an endometriotic chocolate cyst

Abstract

Background: Pelvic inflammatory disease is usually associated with gonococcal sexually transmitted infection. Its association with endometriosis has not been well documented. Case report: The authors report an unusual case of an endometriotic cyst in a 29-year-old nulliparous patient with clinical features of pelvic inflammatory disease. On treatment with antibiotics, the symptomatology subsided and signs of infection diminished. But subsequent imaging revealed a persistent right adnexal mass. A right chocolate cyst was found on laparoscopy and was treated with drainage and enucleation. Patient was administered three doses of GnRH analogs thereafter and is awaiting treatment for infertility. Conclusion: Endometriotic cysts commonly manifest with dyspareunia and dysmenorrhea. The patient in this report presented with signs and symptoms suggestive of pelvic inflammatory disease which was secondary to a slow leak from a chocolate cyst.