# Case Report of Invasive Salmonella Superinfection of an Ovarian Endometrioma in a Patient With Systemic Lupus Erythematosus

## TL;DR

A patient with lupus developed a rare Salmonella infection in an ovarian cyst, requiring surgery and long-term antibiotics due to her weakened immune system.

## Contribution

This case report highlights an unusual manifestation of Salmonella infection in an immunocompromised patient with systemic lupus erythematosus.

## Key findings

- Salmonella superinfection occurred in an ovarian endometrioma in a patient with systemic lupus erythematosus.
- Surgical intervention and prolonged antibiotic therapy were necessary for recovery.
- Immunocompromised status likely contributed to the severity and atypical presentation of the infection.

## Abstract

To present a case of invasive salmonella superinfection of an ovarian endometrioma in a patient with systemic lupus erythematosus, most likely due to exacerbation of a prior infection due to immunocompromised status, and review of literature on the typical and atypical manifestation of salmonella infection.

Case report and mini-review. We used the CARE checklist when writing our report.

For diagnosis of Salmonella bacteremia, cultures were used. Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) was used to further diagnose the patient with Salmonella enterica ssp. diarizonae.

University-based OBGYN service.

A 40-year-old G3P3003 female, initially presenting with nausea, non-bloody emesis, watery diarrhea, subjective fevers, and extreme fatigue, was found to have positive cultures for salmonella infection. Cefepime was administered with subsequent marked improvement in symptoms. Patient represented 2 months later with abdominal pain and fever and was confirmed to have a salmonella-infected endometrioma.

Explorative laparotomy, right salpingo-oophorectomy, and left adnexal cyst drainage.

Outcome and complication of surgical management of salmonella superinfection of an ovarian endometrioma.

Post-op, the patient experienced post-op fevers until POD7, when her symptoms began to improve significantly. Persistent fevers were attributed to surgical complications involving a cyst rupture during removal. The patient was subsequently discharged with a 6-week course of Ciprofloxacin 500 mg BID and suppressive amoxicillin PO 500 mg BID after completing the Ciprofloxacin regimen due to immunocompromised status.

Assessment for metastasis to other organs is crucial in evaluating immunocompromised patients diagnosed with salmonella infections. Surgical management should be highly considered.