Case presentation A 41-year-old female patient reported to the ED with a pyogenic pelvic inflammatory disease. Her medical history included bowel obstruction at the age of 8 months and three caesarian sections. Symptoms started with lower back pain, and she began taking NSAIDs without remission of symptoms.
Physical examination Temperature: 38.2 o C Abdominal pain in the upper right quadrant and epigastrium Laboratory examination WBC: 14,900/μL, 96% neutrophils Thrombocytopenia (60,000/μL) C-reactive protein: 330 mg/L SGOT: 60 U/L SGPT: 84 U/L γGT: 104 U/L ALP: 160 U/L Total bilirubin: 2.79 mg/dL Direct bilirubin: 2.62 mg/dL Urine cultures did not grow any bacteria CT scan showed no liver and biliary lesions, but the patient developed perirectal abscesses. She also developed tenderness in her right thigh, which aggravated her condition. Inflammatory bowel syndrome was excluded after…
