Management of Tubo-Ovarian Abscess in a Patient With Factor V Leiden Deficiency and High Body Mass Index (BMI)

This case report details the clinical course, diagnostic challenges, and management of a 53-year-old female patient with a history of factor V Leiden deficiency, hypertension, and high body mass index (BMI), presenting with an acute tubo-ovarian abscess (TOA). The patient's medical history also included penicillin allergy, premenopausal bleeding, and two previous cesarean sections, adding complexity to her management. Upon presentation, the patient exhibited symptoms of TOA, a severe complication of pelvic inflammatory disease (PID). Given her high BMI and surgical history, the risks associated with surgical intervention were significant. Consequently, a conservative approach with prolonged antibiotic therapy was chosen. The diagnosis was supported by initial and follow-up CT scans, which revealed multiple fluid collections indicative of infection but did not suggest a safe access route for percutaneous drainage. The patient's penicillin allergy required a careful selection of antibiotics to ensure efficacy and avoid adverse reactions. A multidisciplinary team comprising specialists from gynecology, microbiology, and radiology collaborated to devise and implement an effective treatment plan. This approach allowed for regular reassessment and adjustments to the therapeutic regimen. The patient received broad-spectrum antibiotics tailored to her specific needs, with the regimen prolonged due to the infection's severity and the high risk of surgical complications. The patient's inflammatory markers, including C-reactive protein (CRP) levels, were closely monitored, guiding treatment adjustments. Over time, significant clinical improvement was observed, with a gradual decrease in CRP levels and symptom resolution. This case underscores the importance of a tailored, patient-specific approach in managing complex TOA cases. It highlights the potential for conservative management with antibiotics in high-risk patients where surgical intervention poses significant risks. The successful outcome emphasizes the value of a multidisciplinary approach and individualized care in achieving favorable outcomes in TOA management.