Tidsskr Nor Laegeforen. 2020 Nov 9;140(16). doi: 10.4045/tidsskr.20.0424. Print 2020 Nov 10.
Women of reproductive age who present with abdominal pain and purulent vaginal discharge are commonly seen in primary health care and gynaecological outpatient clinics. Their symptoms are often caused by sexually transmitted infections and efficiently treated with empiric antibiotics. However, in some cases diagnostics are more challenging.
We present the case history of a woman in her twenties with multiple sclerosis under rituximab treatment. She presented with a wide range of symptoms over twelve months, including upper and lower respiratory tract infections, urinary bladder urgency, chronic abdominal pain, diarrhoea, bloody stools, weight loss and fatigue. She underwent urological and gastroenterological examinations which yielded normal findings. After the onset of genital discomfort and copious amounts of vaginal discharge, gynaecological examination and routine microbiological testing of discharge were negative. Finally, she presented with septicaemia and progressive abdominal pain. Laparoscopy was performed due to absence of recovery after initial transvaginal ultrasound-guided aspiration of ovarian cysts. The microbe Ureaplasma urealyticum was detected in ovarian pus. Treatment with doxycycline resulted in full recovery.
It is important to consider opportunistic microbes in immunocompromised patients, as they might pose a major diagnostic challenge and require the involvement of several specialties.
在初级保健和妇科门诊中，经常会遇到有腹痛和脓性阴道分泌物的育龄妇女。这些症状通常是由性传播感染引起的，可以通过经验性抗生素治疗有效。然而，在某些情况下，诊断更具挑战性。
我们介绍了一位接受利妥昔单抗治疗的 20 多岁多发性硬化症女性的病例。她在 12 个月的时间里出现了多种症状，包括上呼吸道和下呼吸道感染、膀胱紧迫感、慢性腹痛、腹泻、血性粪便、体重减轻和疲劳。她接受了泌尿科和胃肠病学检查，结果正常。在出现生殖器不适和大量阴道分泌物后，妇科检查和常规分泌物微生物学检测均为阴性。最后，她出现败血症和进行性腹痛。由于初始经阴道超声引导抽吸卵巢囊肿后没有恢复，因此进行了腹腔镜检查。在卵巢脓液中检测到微生物解脲脲原体。多西环素治疗后完全康复。
在免疫功能低下的患者中，有必要考虑机会性微生物，因为它们可能构成重大诊断挑战，需要涉及多个专业。
