Septic shock after a saline infusion hysterosalpingosonogram in a woman with stage IV endometriosis and infertility: A case report

Saline infusion sonohysterography/hysterosalpingo-contrast sonography is commonly used in the work-up of infertility. Overall, pelvic infection following these investigations is rare, but risk may be increased in patients with deep infiltrating endometriosis. Antibiotic prophylaxis is not professionally recommended in patients with advanced endometriosis, a point that requires reconsideration. A 29-year-old woman with stage IV endometriosis presented with pelvic inflammatory disease and sepsis following a saline hysterosalpingo-contrast sonogram for investigation of infertility. Her infection was resistant to antibiotic treatment and she required extensive surgical intervention for source control, which impacted her fertility. The immunodeficient pelvic microenvironment in patients with endometriosis and endometrioma can increase the risk and severity of pelvic infection. Antibiotic prophylaxis should always be utilized in those with stage IV endometriosis who are due to undergo saline infusion sonohysterography or hysterosalpingo-sonography.