{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:51:15Z","timestamp":1782489075141,"version":"3.54.5"},"reference-count":10,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,3,9]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Tubo-ovarian abscess (TOA) is a severe complication of pelvic inflammatory disease (PID), but it can also occur in women without prior PID or sexually transmitted infections. Recent studies suggest that endometriosis may increase the risk and severity of TOA due to factors such as invasive procedures and the presence of endometriomas, which provide a favourable environment for infection. We report a rare case of an elderly nulligravida who presented with acute abdominal pain and fever. Surgical exploration confirmed TOA involving an endometrioma. The patient underwent pus drainage followed by right salpingo-oophorectomy and appropriate antibiotic therapy, with complete recovery. This case highlights the rare association between endometriosis and TOA, emphasising the need for clinicians to consider this diagnosis in women with endometriosis presenting with acute pelvic symptoms, even in the background of treated genital tuberculosis. Early recognition and prompt surgical management are crucial for reducing morbidity.<\/jats:p>","DOI":"10.1136\/bcr-2025-270647","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T15:45:15Z","timestamp":1775576715000},"page":"e270647","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Unusual presentation of endometriosis as a large tubo-ovarian abscess posing a diagnostic challenge"],"prefix":"10.1136","volume":"19","author":[{"given":"Virupaksha","family":"Ajjammanavar","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology, JSS Medical College, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruthi Kelasur","family":"Rajashekara","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, JSS Medical College, Mysuru, Karnataka, India"},{"name":"Obstetrics and Gynecology, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4631-0314","authenticated-orcid":false,"given":"Sowmyashree","family":"Thimmappa","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, JSS Medical College, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitha","family":"Suresh","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, JSS Medical College, Mysuru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"2026062608153174000_19.4.e270647.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-021-01188-6","article-title":"Risk factors for the development of tubo-ovarian abscesses in women with ovarian endometriosis: a retrospective matched case-control study","volume":"21","author":"Gao","year":"2021","journal-title":"BMC Womens Health"},{"key":"2026062608153174000_19.4.e270647.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-020-01119-x","article-title":"Clinical characteristics, treatment status and complications in women with tube ovarian abscess and endometriosis: a retrospective study","volume":"21","author":"Li","year":"2021","journal-title":"BMC Womens Health"},{"key":"2026062608153174000_19.4.e270647.3","unstructured":"Sarkar Sen S . Ovarian abscess within an endometrioma: risk factors and management. In: S\u00f6zen S , ed. Abscess - Types, Causes and Treatment [Internet]. Available: https:\/\/www.intechopen.com\/chapters\/1160642"},{"key":"2026062608153174000_19.4.e270647.4","doi-asserted-by":"crossref","first-page":"232","DOI":"10.5005\/jp-journals-10006-2628","article-title":"Tubo-ovarian Abscess in Diverse Age-groups: A Case Series","volume":"17","author":"Menon","year":"2025","journal-title":"Journal of South Asian Federation of Obstetrics and Gynaecology"},{"key":"2026062608153174000_19.4.e270647.5","doi-asserted-by":"crossref","first-page":"73","DOI":"10.4103\/ijmy.ijmy_192_24","article-title":"Primary Ovarian Tuberculosis: A Case Report with Unusual Clinical Presentation","volume":"14","author":"Roy","year":"2025","journal-title":"The International Journal of Mycobacteriology"},{"key":"2026062608153174000_19.4.e270647.6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.14740\/jcgo388w","article-title":"Association Between Endometriosis and Tubo-Ovarian Abscess","volume":"5","author":"Tas","year":"2016","journal-title":"J Clin Gynecol Obstet"},{"key":"2026062608153174000_19.4.e270647.7","doi-asserted-by":"crossref","first-page":"704","DOI":"10.18203\/2320-6012.ijrms20230190","article-title":"Tubo-ovarain abscess in patient with ovarian endometriosis","volume":"11","author":"Gupta","year":"2023","journal-title":"Int J Res Med Sci"},{"key":"2026062608153174000_19.4.e270647.8","doi-asserted-by":"crossref","first-page":"471","DOI":"10.30699\/jogcr.9.4.471","article-title":"Tubo-Ovarian Abscess with Highly Elevated CA125 Level is Misdiagnosed as Ovarian Cancer: A Case Report","volume":"9","author":"Ghasemian Dizajmehr","year":"2024","journal-title":"J Obstet Gynecol Cancer Res"},{"key":"2026062608153174000_19.4.e270647.9","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1177\/2284026520960649","article-title":"Tubo-ovarian abscess: Exploring optimal treatment options based on current evidence","volume":"13","author":"Gkrozou","year":"2021","journal-title":"J Endometr Pelvic Pain Disord"},{"key":"2026062608153174000_19.4.e270647.10","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(85)90392-8"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-270647","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:21:27Z","timestamp":1782487287000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-270647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":10,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,7]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2025-270647"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-270647","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}