Uncontrolled Diabetes as the Sole Risk Factor in a Rare Candida glabrata Tubo-Ovarian Abscess

Fungal tubo-ovarian abscesses (TOAs) are rare and often mimic bacterial TOAs clinically and radiographically, frequently resulting in delayed diagnosis. Uncontrolled type 2 diabetes mellitus (T2DM) significantly increases susceptibility to fungal infection through impaired neutrophil function, tissue ischemia, and enhanced Candida colonization. Early recognition is critical, as standard empiric TOA regimens do not provide antifungal coverage. We describe the case of a 36-year-old patient with poorly controlled T2DM (hemoglobin A1c 15.6%) who presented with fever and right-sided abdominal pain. Imaging demonstrated a multiloculated right adnexal fluid collection concerning for TOA. Despite guideline-concordant broad-spectrum antibiotics and interventional radiology-guided drainage, the patient remained persistently febrile with minimal clinical improvement. Abscess aspirate cultures subsequently isolated Candida glabrata, prompting escalation of therapy from fluconazole to micafungin. Given the persistent collection despite prolonged antimicrobial and antifungal therapy, diagnostic laparoscopy with surgical drainage was performed, resulting in clinical resolution. This case highlights the importance of maintaining a high index of suspicion for fungal TOA in patients with refractory disease, particularly in the setting of uncontrolled diabetes, and underscores the need for early culture acquisition, timely initiation of anti-fungal therapy, and substantial consideration concerning operative source control.