Bilateral Ovarian Vein Thrombosis in a Non-Pregnant Woman: A Case Report.

Ovarian vein thrombosis (OVT) is a rare vascular disorder most commonly associated with pregnancy and the puerperium; however, it may also occur in non-pregnant women, in whom diagnosis can be challenging because of its rarity and nonspecific clinical presentation. We report the case of a 37-year-old non-pregnant woman with no significant past medical history who presented with a one-month history of undocumented fever associated with right lower quadrant abdominal pain and constitutional symptoms, including weight loss, night sweats, and fatigue. She had delivered nine months before presentation, well beyond the recognized high-risk postpartum period, and denied oral contraceptive use. Laboratory investigations were largely unremarkable, except for a markedly elevated erythrocyte sedimentation rate. Contrast-enhanced computed tomography of the abdomen and pelvis demonstrated bilateral OVT. The patient was admitted with a working diagnosis of fever of unknown origin and was started on therapeutic anticoagulation with low-molecular-weight heparin, followed by a transition to apixaban. Her condition improved clinically, and a structured follow-up plan was arranged. Bilateral OVT in the absence of pregnancy is particularly uncommon and may be overlooked because of the lack of specific clinical and laboratory findings, making imaging essential for diagnosis. Early initiation of anticoagulation is important to reduce the risk of potentially life-threatening complications. Although direct oral anticoagulants are increasingly used in the management of venous thromboembolism, evidence supporting their use specifically in non-pregnancy-related OVT remains limited. This case highlights bilateral OVT as a rare but important cause of prolonged fever and abdominal pain in non-pregnant women and emphasizes the need for early recognition to avoid diagnostic delay and ensure timely management.