Article in Japanese

Prepubertal bacterial vaginosis complicated by endomyometritis presenting with fever of unknown origin: A case report

Hiroyuki ESAKI¹⁾, Yoshikazu OTSUBO¹⁾, Eiko TONE²⁾, Yumi MATSUO²⁾, Hiroyuki MORIUCHI³⁾

Bacterial vaginosis, the most common vaginal infection in women from puberty until menopause, is often asymptomatic or may present with vaginal discharge and itching; however, it rarely causes fever and systemic symptoms. Here, we discuss the case of a prepubertal girl presenting with fever of unknown origin and was subsequently diagnosed with bacterial vaginosis with ascending uterine infection.
A 1-year-old girl was referred to our institution because of a 3-day history of fever and an elevated C-reactive protein level with no localizing sign. Purulent vaginal discharge was unexpectedly observed while inserting a urinary catheter. Contract-enhanced computed tomography showed dilatation and fluid collection in the vagina as well as contrast enhancement of the uterine cervix and corpus compatible with endomyometritis. Culture of vaginal discharge revealed Escherichia coli.
The present case suggests that reproductive tract infections should be considered as a differential diagnosis of fever of unknown origin in prepubertal girls. Since neither patients nor parents may voluntarily complain of vaginal discharge, careful history taking and physical examination are needed for the diagnosis of bacterial vaginosis.

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1) Department of Pediatrics, Sasebo City General Hospital
2) Department of Clinical Laboratory, Sasebo City General Hospital
3) Department of Pediatrics, Nagasaki University Hospital

Key words	vaginal discharge, reproductive tract infections, bacterial vaginosis, ascending infection, fever of unknown origin
Received	August 12, 2020
Accepted	February 1, 2021

33 (2)：101─106,2021