Ovarian abscess caused by Helicobacter cinaedi in a patient with endometriosis

Abstract

Helicobacter cinaedi is a rarely encountered pathogen that easily induces bacteremia. Various foci of H. cinaedi infection have been reported; however, no case of adnexal abscess caused by H. cinaedi has been reported in the English literature. We herein report a case of ovarian abscess caused by H. cinaedi. A 38-year-old nulligravid Japanese woman was admitted to our hospital with an adnexal abscess. Clinical findings included fever, leukocytosis, and elevated C-reactive protein. Laparoscopic right partial oophorectomy with abdominal lavage was performed. H. cinaedi was isolated from cultures of blood and ovarian abscess fluid after surgery. Intravenous ampicillin/sulbactam was administered for 2 weeks, followed by oral amoxicillin for an additional 2 weeks. The postoperative course was uneventful and clinical findings improved. There was no evidence of relapse. H. cinaedi can cause ovarian abscess and is likely an under-recognized pathogen.

Keywords: Abscess; Endometriosis; Helicobacter; Laparoscopy; Ovary.

Fig. 1

Enhanced abdominal computed tomography reveals a well-enhanced, double-lobed ovarian cyst with a thick wall.

Fig. 2

Laproscopy revealed mild adhesion between the right ovarian cyst and the retroperitoneum. findings. The right fallopian tube(2A, Arrow head) and the left adnexa(2B, Arrow) were grossly normal. Uterine leiomyoma was shown at uterine fundus.

Fig. 3

Gram staining of spiral bacteria isolated in blood culture.(×1000).

Fig. 4

On histopathology of right ovary, many neutrophils are seen in the ovarian epithelium and stroma(4A, Hematoxylin-Eosin stain, ×20). The low cuboidal epithelium with hemosiderosis is consistent with an endometrial cyst(4B, Hematoxylin-Eosin stain ×200).