Non Typhoidal Salmonella Suppuration of Ovarian Cyst with Sclerosing Peritonitis: An old disease, A New Face

Abstract

Invasive non-typhoidal Salmonella is an emerging problem in developing regions like Africa and Asia. Infection of ovarian cysts by typhoid bacilli is a complication dating to the 1800s and is rare in the postantibiotic era. A diabetic, hypertensive post-menopausal lady, our patient presented with a large paraovarian cyst infected the Salmonella group B bacillus. The infection is likely transmitted hematogenously or by the surrounding adherent bowel and omentum. Interestingly, our patient developed sclerosing peritonitis and osseous metaplasia of the rectus sheath as well, possibly a peritoneal inflammation to a disseminated infection. Compounded by her diabetes, the ossified rectus healed poorly, leading to burst abdomen in the post-operative period. Hence, our patient presented with a rare manifestation of an emerging disease. A depressed immune status, influenced by her comorbidities, and the lack of sanitation in pockets of South Asia may have led to a reappearance of these once historic complications of typhoid.