{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T13:44:15Z","timestamp":1782135855079,"version":"3.54.5"},"reference-count":14,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,9,5]]},"abstract":"<jats:p>A 44-year-old Caucasian female with a history of endometriosis is admitted to the intensive care unit due to severe left lower quadrant abdominal pain, nausea and vomiting. With patients\u2019 positive chandelier sign on pelvic examination, leucocytosis, elevated erythrocyte sedimentation rate and elevated C-reactive protein indicated that she had pelvic inflammatory disease (PID). PCR tests were negative for<jats:italic>Neisseria gonorrhoeae<\/jats:italic>and<jats:italic>Chlamydia trachomatis<\/jats:italic>; however, her blood and urine cultures grew Group A streptococci (GAS) with a negative rapid<jats:italic>Streptococcus<\/jats:italic>throat swab and no known exposure to<jats:italic>Streptococcus<\/jats:italic>. On further review, patient met criteria for GAS toxic shock syndrome based on diagnostic guidelines. The patient was promptly treated with intravenous antibiotics and supportive care, and she acutely recovered. This case demonstrates a rare cause of PID and an atypical aetiology of severe sepsis. It illuminates the importance of considering PID as a source of infection for undifferentiated bacteraemia.<\/jats:p>","DOI":"10.1136\/bcr-2018-224955","type":"journal-article","created":{"date-parts":[[2018,9,24]],"date-time":"2018-09-24T03:55:17Z","timestamp":1537761317000},"page":"bcr-2018-224955","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Uncommon cause of pelvic inflammatory disease leading to toxic shock syndrome"],"prefix":"10.1136","volume":"2018","author":[{"given":"Heather","family":"Lusby","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Brooks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eden","family":"Hamayoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Finley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,9,23]]},"reference":[{"key":"2025042706211239000_2018.sep22_1.bcr-2018-224955.1","first-page":"87","article-title":"Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents","volume":"8","author":"Risser","year":"2017","journal-title":"Adolesc Health Med Ther"},{"key":"2025042706211239000_2018.sep22_1.bcr-2018-224955.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1411426"},{"key":"2025042706211239000_2018.sep22_1.bcr-2018-224955.3","unstructured":"Workowski KA , Bolan GA . 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Bacterial isolated associated with pelvic inflammatory disease among female patients attending some hospitals in Abuja, Nigeria [Internet]. 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