Septic abortion presenting as a right lower trapezius abscess secondary to Bacteroides fragilis bacteraemia.

Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 101526291 Publication Model: Electronic Cited Medium: Internet ISSN: 1757-790X (Electronic) Linking ISSN: 1757790X NLM ISO Abbreviation: BMJ Case Rep Subsets: MEDLINE

Original Publication: London : BMJ Pub. Group

Abortion, Septic/*diagnosis ; Abscess/*diagnostic imaging ; Bacteremia/*complications ; Bacteroides fragilis/*isolation & purification ; Superficial Back Muscles/*pathology; Abortion, Septic/drug therapy ; Abortion, Septic/microbiology ; Abortion, Septic/surgery ; Abscess/drug therapy ; Abscess/microbiology ; Abscess/surgery ; Adult ; Ampicillin/administration & dosage ; Ampicillin/therapeutic use ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/therapeutic use ; Aztreonam/administration & dosage ; Aztreonam/therapeutic use ; Bacteremia/drug therapy ; Bacteremia/microbiology ; Bacteremia/pathology ; Bacterial Infections/drug therapy ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; Pregnancy/urine ; Shoulder/diagnostic imaging ; Sulbactam/administration & dosage ; Sulbactam/therapeutic use ; Superficial Back Muscles/microbiology ; Superficial Back Muscles/surgery ; Tomography, X-Ray Computed ; Treatment Outcome

A 43-year-old Japanese woman was evaluated in the outpatient department for right shoulder pain and fever, which began 5 days earlier. MRI of the right shoulder revealed a high-intensity area deep in the right trapezius muscle. Aspiration revealed purulent fluid, and Gram staining of the fluid showed Gram-negative bacilli. The patient was also found to be profoundly anaemic and to have a positive urine pregnancy test. On admission, we initiated intravenous ampicillin-sulbactam and aztreonam. She underwent dilatation and curettage for septic abortion and surgical drainage of the right shoulder abscess. Bacteroides fragilis was isolated from the blood, uterine aspiration and abscess samples. On hospital day 4, a whole-body CT scan revealed no other abscesses, and ampicillin-sulbactam was continued for 28 days. The patient was discharged on hospital day 29. Gram staining is an important tool for evaluating infectious aetiologies.
Competing Interests: Competing interests: None declared.
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Clin Infect Dis. 2000 Jun;30(6):901-7. (PMID: 10852812)
Rev Infect Dis. 1991 Jul-Aug;13(4):633-6. (PMID: 1925283)
J Appl Microbiol. 2011 May;110(5):1105-28. (PMID: 21332897)
J Obstet Gynaecol India. 2014 Aug;64(4):265-9. (PMID: 25136172)
Clin Infect Dis. 1996 Dec;23 Suppl 1:S97-101. (PMID: 8953114)

Keywords: infections; obstetrics,gynaecology and fertility

0 (Anti-Bacterial Agents)
7C782967RD (Ampicillin)
G2B4VE5GH8 (Aztreonam)
S4TF6I2330 (Sulbactam)

Date Created: 20170823 Date Completed: 20180514 Latest Revision: 20200225

20221213

PMC5612513

10.1136/bcr-2016-219135

28827296