Unusual presentation of endometriosis as a large tubo-ovarian abscess posing a diagnostic challenge

Article Text Abstract Tubo-ovarian abscess (TOA) is a severe complication of pelvic inflammatory disease (PID), but it can also occur in women without prior PID or sexually transmitted infections. Recent studies suggest that endometriosis may increase the risk and severity of TOA due to factors such as invasive procedures and the presence of endometriomas, which provide a favourable environment for infection. We report a rare case of an elderly nulligravida who presented with acute abdominal pain and fever. Surgical exploration confirmed TOA involving an endometrioma. The patient underwent pus drainage followed by right salpingo-oophorectomy and appropriate antibiotic therapy, with complete recovery. This case highlights the rare association between endometriosis and TOA, emphasising the need for clinicians to consider this diagnosis in women with endometriosis presenting with acute pelvic symptoms, even in the background of treated genital tuberculosis. Early recognition and prompt surgical management are crucial for reducing morbidity. - Obstetrics, gynaecology and fertility - Endoscopy - TB and other respiratory infections - Radiology Statistics from Altmetric.com Footnotes Contributors SKR and HS did the drafting of the text, sourcing and editing of images. VA and SST gave the final approval of the manuscript. Guarantor: SKR. Zotero application for referencing. Grammarly for correction of grammar. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy. Competing interests None declared. Provenance and peer review Not commissioned; externally peer reviewed.