{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T15:57:42Z","timestamp":1765382262727,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,9,24]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>A 43-year-old woman with a history of bilateral tubal ligation and bilateral ovarian cysts presented to our hospital with progressively worsening right lower quadrant pain and abdominal distension. Her exam findings of vaginal discharge and cervical motion tenderness, in combination with her marked leucocytosis, were suggestive of pelvic inflammatory disease (PID). PCR for <jats:italic>Chlamydia trachomatis<\/jats:italic> and <jats:italic>Neisseria gonorrhoeae<\/jats:italic> was negative, however, our patient\u2019s blood cultures grew group A <jats:italic>Streptococcus<\/jats:italic>. This exceptionally severe presentation of PID, in combination with uncommon laboratory findings, led to complex multidisciplinary clinical decision making guided by extensive literature review. Here, we present a rare case of group A <jats:italic>Streptococcus<\/jats:italic> PID after bilateral tubal ligation, and highlight the role of a family medicine primary team in the medical and surgical management of a complex case at a community hospital.<\/jats:p>","DOI":"10.1136\/bcr-2020-236326","type":"journal-article","created":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T17:06:06Z","timestamp":1603818366000},"page":"e236326","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Complex clinical management of group A <i>Streptococcal<\/i> pelvic inflammatory disease after bilateral tubal ligation in a small community hospital"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7012-2770","authenticated-orcid":false,"given":"Emily","family":"Wolfenden","sequence":"first","affiliation":[{"name":"College of Medicine, The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maanvi","family":"Mittal","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Stanford Health Care, San Jose, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Sussman","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Stanford Health Care, San Jose, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,10,27]]},"reference":[{"key":"2025082803541020000_13.10.e236326.1","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1056\/NEJMra1411426","article-title":"Pelvic inflammatory disease","volume":"372","author":"Brunham","year":"2015","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082803541020000_13.10.e236326.2","first-page":"752","article-title":"Acute pelvic inflammatory disease after tubal sterilization. A report of three cases","volume":"39","author":"Reedy","year":"1994","journal-title":"J Reprod Med"},{"key":"2025082803541020000_13.10.e236326.3","first-page":"25","article-title":"Acute appendicitis: efficient diagnosis and management","volume":"98","author":"Snyder","year":"2018","journal-title":"Am Fam Physician"},{"key":"2025082803541020000_13.10.e236326.4","doi-asserted-by":"publisher","DOI":"10.1148\/rg.243035084"},{"key":"2025082803541020000_13.10.e236326.5","first-page":"519","article-title":"Diagnosis and treatment of acute pyelonephritis in women","volume":"84","author":"Colgan","year":"2011","journal-title":"Am Fam Physician"},{"key":"2025082803541020000_13.10.e236326.6","doi-asserted-by":"publisher","DOI":"10.1148\/rg.281075171"},{"key":"2025082803541020000_13.10.e236326.7","unstructured":"Centers for Disease Control and Prevention . \u201c2015 Sexually Transmitted Diseases Treatment Guidelines: Pelvic Inflammatory Disease (PID).\u201d CDC, 2015.. Available: https:\/\/www.cdc.gov\/std\/tg2015\/pid.htm [Accessed May 2020]."},{"key":"2025082803541020000_13.10.e236326.8","first-page":"357","article-title":"Pelvic inflammatory disease: diagnosis, management, and prevention","volume":"100","author":"Curry","year":"2019","journal-title":"Am Fam Physician"},{"key":"2025082803541020000_13.10.e236326.9","unstructured":"Centers for Disease Control and Prevention . \u201cStreptococcal Toxic Shock Syndrome (STSS) (Streptococcus pyogenes) 2010 Case Definition.\u201d CDC, 2010. Available: https:\/\/wwwn.cdc.gov\/nndss\/conditions\/streptococcal-toxic-shock-syndrome\/case-definition\/2010\/ [Accessed October 2019]."},{"key":"2025082803541020000_13.10.e236326.10","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2009615"},{"key":"2025082803541020000_13.10.e236326.11","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.ijscr.2014.10.060","article-title":"Group A streptococci: a rare and often misdiagnosed cause of spontaneous bacterial peritonitis in adults","volume":"6","author":"Malota","year":"2015","journal-title":"Int J Surg Case Rep"},{"key":"2025082803541020000_13.10.e236326.12","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2018-224955","article-title":"Uncommon cause of pelvic inflammatory disease leading to toxic shock syndrome","volume":"2018","author":"Lusby","year":"2018","journal-title":"BMJ Case Rep"},{"key":"2025082803541020000_13.10.e236326.13","doi-asserted-by":"crossref","first-page":"e208","DOI":"10.1016\/j.ijid.2009.07.014","article-title":"Severe group A streptococcal toxic shock syndrome presenting as primary peritonitis: a case report and brief review of the literature","volume":"14 Suppl 3","author":"Tilanus","year":"2010","journal-title":"Int J Infect Dis"},{"key":"2025082803541020000_13.10.e236326.14","doi-asserted-by":"publisher","DOI":"10.1155\/S1064744902000194"},{"key":"2025082803541020000_13.10.e236326.15","doi-asserted-by":"publisher","DOI":"10.1097\/00006254-200001000-00022"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-236326","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:54:20Z","timestamp":1756378460000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-236326"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":15,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,10,27]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1136\/bcr-2020-236326"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-236326","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,10]]}}}