Non-Sexual Pelvic Inflammatory Disease in a Virginal Patient Resulting in Catatonic Conversion Reaction
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Mary Ann Liebert, Inc. 2016. Background: Pelvic inflammatory disease (PID) could result in long-term gynecologic sequelae, including chronic pelvic pain, infertility, and ectopic pregnancy. Most cases are associated with sexually transmitted infections, with the diagnosis often overlooked in virginal patients. The purpose of this case report is to highlight PID as a diagnostic possibility even in virginal females who have risk factors for its occurrence. In this case, the diagnosis and subsequent treatment were complicated by the patient's psychogenic, altered mental status. Case: A 43-year-old gravida 0, virginal, African-American patient, with a history of douching, presented with lower pelvic pain and fever 2 weeks after her last menstrual period. Her physical examination was compatible with PID; douching was her isolated risk factor for upper genital-tract infection. After laparoscopic tubal drainage, the patient lapsed into a catatonic state. Results: Laboratory data revealed leukocytosis; transvaginal ultrasound revealed bilateral hydrosalpinges. Endocervical DNA probes were negative for Neisseria and Chlamydia. Despite intravenous antibiotics, no improvement occurred. Diagnostic laparoscopy confirmed hydrosalpinges, with needle drainage revealing purulence. Culture of the aspirate revealed Escherichia coli as the pathogen. Clinical improvement followed; however, this patient lapsed into a catatonic conversion reaction. Neurologic assessment confirmed an absence of organic pathology for the catatonia. She was subsequently transferred for inpatient rehabilitation and psychiatric evaluation. Conclusions: PID can occur in virginal women, particularly in those who douche. Patients with ill-equipped coping mechanisms might develop a form of post-traumatic stress disorder following a medical diagnosis of PID, with possible progression to a conversion reaction.
