Oophoritis is a term describing inflammation of the ovaries, and it is primarily considered as one of the variants of pelvic inflammatory disease, an infection of the upper genital tract in women. However, xanthomatous and autoimmune forms of infection and inflammation, respectively, have been recognized. Oophoritis can be life-threatening if progression to peritonitis or sepsis occurs, which is why an early diagnosis is vital.
Oophoritis is rarely used in literature as a distinct term for infection or inflammation of the ovaries. In most cases, it is described as a component of pelvic inflammatory disease (PID), an infection of the female upper genital tract that has spread from the cervix (cervicitis), endometrium (endometritis) and the fallopian tubes (salpingitis) [1] [2] [3] [4]. In such instances, symptoms are high fever (> 38.5°C), abdominal and/or back pain, cervical discharge, dyspareunia, bleeding, vomiting and lower urinary tract infection (UTI) like signs - dysuria, polyuria, and an unpleasant odor [2] [3] [4]. Women msy be asymptomatic in the initial stages which may be a significant challenge for the diagnosis for the physician. Notable pathogens that can cause oophoritis are mumps (in approximately 5% of cases, with similar symptoms to PID), mycobacterium tuberculosis in its extrapulmonary forms (characterized by chronic pelvic pain, sterility or the development of ectopic pregnancy), whereas the term xanthomatous oophoritis is used to describe a chronic and destructive infection caused by escherichia coli, actinomycosis, proteus spp. or staphylococcus aureus [1] [5] [6]. Xanthomatous oophoritis, like other forms of infectious oophoritis, occurs as a complication of PID [3]. Endometriosis, inappropriate antimicrobial therapy, radiotherapy, the presence of an intrauterine device (IUD) and inborn errors of lipid metabolism are considered as risk factors [3]. Apart from infections, an autoimmune form of oophoritis is recognized in the literature, most commonly seen in premature ovarian failure (POF) that presents with amenorrhea and hypoestrogenism in women of child-bearing age (usually younger than 40 years) [7] [8].
To make the diagnosis of oophoritis, it is imperative to conduct a thorough patient history that will note the appearance and course of symptoms, as well as risk factors and preexisting conditions that may predispose women to an infection [2] [7]. A detailed physical examination should follow, with an emphasis on the inspection and palpation of the abdomen, especially the right upper quadrant, and a complete gynecological exam (including bimanual and a vaginal speculum exam that will inspect the cervix, cervical motion, and assess the presence of a pelvic mass that may point to an abscess) [2] [4]. Uterine, adnexal, or cervical motion tenderness, together with high fever and abdominal pain are hallmarks of PID and oophoritis. The diagnosis is often made solely on clinical grounds, but the use of laboratory and imaging studies are used for confirmation [2] [4]. A complete blood count (CBC) will almost always show leukocytosis, while erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and fibrinogen are important inflammatory parameters that are frequently elevated [2] [4]. Abdominal (or sometimes vaginal) ultrasonography, computed tomography (CT) or magnetic resonance imaging (MRI) can all be used to identify the exact stage of PID and confirm oophoritis [2] [3] [4]. An extensive microbiological investigation, however, is essential in women with suspected infection of the upper genital tract. Cultivation of cervicovaginal discharge, serology testing (if suspicion toward mumps exists), and polymerase chain reaction (PCR) testing can be used to identify the microorganism responsible for the infection [6] [7] [8].