A rare case of large pyosalpinx in an elderly patient with well-controlled type 2 diabetes mellitus: a case report

Abstract

Background: Pyosalpinx, which is one of the pelvic inflammatory diseases, is usually observed in young women; it is rarely found in older women. Possible causative agents are thought to be Chlamydia trachomatis and Neisseria gonorrhea in addition to some Enterobacteriaceae. On the other hand, type 2 diabetes is a disease with a lot of complications such as hyperglycemia, inflammation, and immune disorders. Therefore, patients with type 2 diabetes mellitus have an increased susceptibility to infection especially when glycemic control is poor.

Case presentation: We experienced a rare case of large pyosalpinx in an elderly patient with well-controlled type 2 diabetes mellitus. A 72-year-old Japanese woman with a 10-year history of type 2 diabetes mellitus had symptoms of diarrhea and persistent pain in left lower abdomen. She had mild tenderness to palpation in her abdomen. Inflammation markers were markedly elevated. Her abdominal computed tomography and magnetic resonance imaging on admission revealed a tumor in left side of intrapelvis and we diagnosed her as having pyosalpinx. Pathogenic bacteria were not detected. On admission, her glycemic control was relatively good; in addition, her glycated hemoglobin levels were around 6% for over 1 year. Although pathogenic bacteria were not detected, we started antibiotics therapy. Fourteen days after starting the antibiotics her laboratory data were improved. Three months later, the tumor was markedly smaller compared to that on admission.

Conclusions: We should keep in mind that older patients with type 2 diabetes mellitus are immunocompromised hosts and thereby they could have rare pelvic inflammatory disease such as pyosalpinx even when good glycemic control is obtained for a long period of time.

Keywords: Case report; Elderly patient; Pyosalpinx; Type 2 diabetes mellitus.

Fig. 1

Abdominal computed tomography (CT) one year before (upper left panel), on admission (upper middle panel), 25 days later (upper right panel), 3 months later (lower left panel) and 6 months later (lower middle panel). Abnormal CT on admission showed a large tumor with calcification in the pelvis which was observed in abdominal CT one year before. Its size is as large as 65 mm in diameter (upper middle panel). Its tumor size was gradually reduced 25 days later (upper right panel), 3 months later (lower left panel) and 6 months later (lower middle panel) compared to that on admission (upper middle panel), but the tumor did not disappear completely even 6 months later. The arrows show the tumor which reduced in size at time course

Fig. 2

Magnetic resonance imaging axial T1-weighted images through the pelvis showed a markedly dilated fallopian tube posterior to the left ovary. Axial T2-weighted images showed a slightly higher intensity. Axial diffusion-weighted images and contrast-enhanced T1-weighted images showed a high intensity lesion at the same place. CET1W contrast-enhanced T1-weighted image, DWI diffusion-weighted image, T1W T1-weighted image, T2W T2-weighted image

Fig. 3

Time course of medication and inflammation markers. Closed triangle, CRP; closed square, WBC; open square, Neut; closed circle, HbA1c; open circle, glycoalbumin. CRP C-reactive protein, HbA1c, LVFX levofloxacin, Neut neutrophil, TAZ/PIPC tazobactam/piperacillin, WBC white blood cell