Abstract
Abstract Tubo-ovarian abscess (TOA) represents a severe complication of pelvic inflammatory disease (PID) and can lead to significant morbidity if not promptly diagnosed and managed. We reported a case of a 36-year-old Palestinian woman who presented with fever and severe lower abdominal pain, initially diagnosed as acute pyelonephritis, but later found to have bilateral tubo-ovarian abscesses complicated by extended-spectrum beta-lactamase (ESBL) infection. The case underscores the challenges in managing complex pelvic infections and highlights the importance of timely intervention and tailored antibiotic therapy. Keywords: Pyosalpinx, tubo-ovarian abscess, peritonitis, pelvic inflammatory disease.
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