A Para-Ovarian Cyst Infected With Salmonella: A Case Report

Extraintestinal Salmonella infections are rare, even in ovarian cysts, and a Salmonella-infected para-ovarian dermoid cyst has not been reported in the literature. A 19-year-old unmarried girl was admitted with a complaint of high-grade continuous fever that was non-amenable to antipyretics. Evaluation revealed leukocytosis with negative blood and stool cultures and positive IgM levels for Salmonella. Imaging showed a large pelvic mass with mixed fat densities, focal calcification, fluid in the pelvis, and patchy fluorodeoxyglucose (FDG) avidity abutting both ovaries and a few pelvic lymph nodes. A lower midline laparotomy was performed, revealing a large pelvic mass separate from the right ovary, which was excised while preserving the ovary. Tufts of hair, focal calcification, and free-flowing pus were seen inside the mass. Examination showed a dermoid with Salmonella infection. We report the first case of Salmonella infection of a para-ovarian dermoid cyst. Extraintestinal manifestations of Salmonella are known, but ovarian involvement is rare, and para-ovarian involvement has not been reported. We highlight the importance of an extensive search for a cause with blood investigations and imaging to reach a conclusive diagnosis. Even in the absence of positive blood and stool cultures, Salmonella can cause infection at unusual sites. Imaging studies may not differentiate between ovarian and para-ovarian cysts, and an infection may mimic a neoplasm on PET scan. Exploration should be performed with excision of the para-ovarian mass, preserving the ovaries when possible.