Diagnostic Dilemma of Non-resolving Tubal Abscess Caused by Citrobacter amalonaticus Due to Labial Adhesion in a Patient with Pyelonephritis Caused by Escherichia coli, Pyometra and Bacteremia Caused by Bacteroides fragilis.

A 75-year-old woman was hospitalized because of sudden impairment of mobility, fever, and abdominal tenderness. Abdominal ultrasonography and computed tomography revealed a tumorous mass in the left adnexa. Escherichia coli, and Bacteroides fragilis were detected in urine and blood cultures, respectively. Despite ceftriaxone therapy, the fever persisted. B. fragilis was detected in the uterine pus after separation of vulvar adhesions and uterine drainage. The symptoms persisted, despite changing to ampicillin-sulbactam. Citrobacter amalonaticus was detected in the abscess after resection of the left fallopian tube and intra-abdominal drainage. After changing to cefepime, there was no recurrence of the abscess. C. amalonaticus should be considered for patients with urinary tract abnormalities.