Pelvic Salmonella infection masquerading as gynecologic malignancy

BACKGROUND: Salmonella species tubo-ovarian abscess is a rare clinical occurrence. Salmonella organisms are gastrointestinal pathogens that are not thought to create disease with sufficient spread or severity to result in intraperitoneal extension. CASE: A 32-year-old nulligravid woman presented with abdominal pain, fever, and bloody diarrhea. On imaging, she was found to have complex pelvic masses highly suspicious for neoplasm. Surgical exploration revealed tubo-ovarian abscesses and peritonitis. The ovarian tissue culture revealed a Salmonella infection. The final pathology showed bilateral ovarian abscesses and an endometriotic cyst in the right ovary. After a 6-week course of antibiotics, tissue cultures were negative for Salmonella infection, and the patient has remained asymptomatic with normal menstrual cycles. CONCLUSION: Preoperative evaluation of a pelvic mass in a reproductive-aged woman continues to be challenging, with a broad differential diagnosis. Although obstetrician-gynecologists rely on radiographic imaging for diagnosis, the results can be misleading.