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<p>Pelvic inflammatory disease (PID) is an infection-induced inflammation of the upper female genital tract, which may involve the endometrium, fallopian tubes, ovaries, or pelvic peritoneum. Although <i>Neisseria gonorrhoeae</i> and <i>Chlamydia trachomatis</i> are well-established etiologic agents, anaerobic bacteria are increasingly recognized as significant contributors, particularly following intrauterine device (IUD) placement. Although best known as part of the oropharyngeal flora, <i>Fusobacterium necrophorum</i> also colonizes the gastrointestinal and female urogenital tracts and is a rare cause of PID. Its pathogenic potential outside the head and neck region is seldom reported, and fatal cases are exceptionally uncommon. In this case, a 46-year-old woman was found deceased at home approximately one month after IUD insertion. Postmortem examination revealed diffuse fibrinopurulent peritonitis, acute salpingitis, and a right ovarian cyst with surrounding inflammation. Cultures of peritoneal fluid and spleen were positive for <i>F. necrophorum</i>, confirming bacteremia. The cause of death was determined to be PID due to <i>F. necrophorum</i> infection. The IUD placement was considered a plausible contributing factor in the ascending infection. This case represents an exceedingly rare instance of fatal pelvic inflammatory disease caused by <i>F. necrophorum</i>. It highlights the importance of comprehensive microbiological investigations, integration of histopathological findings, and maintaining a broad differential diagnosis in forensic autopsy cases presenting with severe pelvic sepsis.</p>

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Fatal pelvic inflammatory disease caused by Fusobacterium necrophorum: case report and literature review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月3日

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  • Matias Cortes,
  • Ilaria Tarozzi,
  • Meredith Reynolds,
  • Lorenzo Gitto

摘要

Pelvic inflammatory disease (PID) is an infection-induced inflammation of the upper female genital tract, which may involve the endometrium, fallopian tubes, ovaries, or pelvic peritoneum. Although Neisseria gonorrhoeae and Chlamydia trachomatis are well-established etiologic agents, anaerobic bacteria are increasingly recognized as significant contributors, particularly following intrauterine device (IUD) placement. Although best known as part of the oropharyngeal flora, Fusobacterium necrophorum also colonizes the gastrointestinal and female urogenital tracts and is a rare cause of PID. Its pathogenic potential outside the head and neck region is seldom reported, and fatal cases are exceptionally uncommon. In this case, a 46-year-old woman was found deceased at home approximately one month after IUD insertion. Postmortem examination revealed diffuse fibrinopurulent peritonitis, acute salpingitis, and a right ovarian cyst with surrounding inflammation. Cultures of peritoneal fluid and spleen were positive for F. necrophorum, confirming bacteremia. The cause of death was determined to be PID due to F. necrophorum infection. The IUD placement was considered a plausible contributing factor in the ascending infection. This case represents an exceedingly rare instance of fatal pelvic inflammatory disease caused by F. necrophorum. It highlights the importance of comprehensive microbiological investigations, integration of histopathological findings, and maintaining a broad differential diagnosis in forensic autopsy cases presenting with severe pelvic sepsis.