Chronic Serratiaodorifera Infra-vesical, Extra-peritoneal Pelvic Abscess: an Unexpected Finding in a Healthy 18 year Old Girl

Abstract

Background: Serratiaodorifera (S. odorifera), a rare nosocomial human pathogen, is responsible for a few cases and outbreaks of sepsis in very sick hospitalized patients.
Case Report: We report the case of an 18 year old healthy female patient with a chronic, deep, extra-peritoneal pelvic infection by S. odorifera in a Human Immunodeficiency Virus (HIV) endemic region. She had no  constitutional symptoms. In the Serratia genus, Serratiamarcescens is the most pathogenic, infecting virtually all human organ systems, where-as S. odoriferararely infects healthy patients. Our patient presented with chronic
mild pelvic pain. Radiological evaluation revealed a cystic mass lesion of 80mm diameter which was thought to be an ovarian cyst. The mass could not be found at laparotomy. Repeat radiological evaluation revealed that the mass was extra-peritoneal with very thick walls. It was located para-vaginally, below and in front of the urinary bladder. Laparoscopic exploration nine months after laparotomy revealed an abscess with 200ml of pus. She was treated with antibiotics. Anaerobic culture yielded a profuse growth of S.odorifera. Histopathological tissue review confirmed a chronic suppurative abscess. We believe this was a community acquired S.  odorifera infection affecting an otherwise healthy patient. The patient was discharged home well eight days later.

Key words: chronic pelvic abscess, community acquired, HIV infection, immunodeficiency, Serratiaodorifera