A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative. Labs: CBC-WBC 18, Hgb 16, Hct 44, Plat 325, Â Neuts & Lymphs, sed rate 46 mm/hr, C-reactive protein 67 mg/L CMP wnl Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2 99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. Pelvic exam demonstrates copious foul-smelling green drainage with the reddened cervix and + bilateral adnexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram-negative diplococci.
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