Pelvic inflammatory disease: presentation, diagnosis, and management in a clinical case

Abstract

Pelvic inflammatory disease (PID) is an infection of the upper genital tract of polymicrobial etiology that affects women of reproductive age and can lead to complications such as infertility, ectopic pregnancy, and chronic pelvic pain. The study aimed to analyze the clinical, epidemiological, and therapeutic factors that influenced the presentation, diagnosis, and evolution of PID in a 24-year-old Ecuadorian patient. A case study was conducted, collecting clinical data, physical examination, complementary studies, and therapeutic response. The patient presented with progressive pelvic pain, foul-smelling leukorrhea, fever, and dysuria, with persistent symptoms despite initial antibiotic treatment. Examination revealed cervical motion tenderness, endocervical leukorrhea, and bulging of the Douglas pouch, findings compatible with complicated PID. Hematology showed leukocytosis and elevated inflammatory markers, while ultrasound revealed free fluid in the Douglas pouch, confirming the diagnosis. Empirical treatment with cephalosporins and doxycycline was adjusted due to lack of clinical improvement. PID remains a diagnostic challenge due to its variable presentation and the absence of pathognomonic signs. An integral clinical approach, based on early identification of symptoms and the use of appropriate diagnostic tools, is essential to reduce complications. The need for preventive strategies and early detection of sexually transmitted infections is emphasized to minimize the impact of this pathology on women's reproductive health.