]> 2026-07-31T09:40:01+00:00 WBR0061 0 en Gram-positive, catalase-positive coccus Dimorphic fungus Gram-negative, maltose-fermenting diplococci Gram-positive, catalase-negative coccus Gram-negative, maltose-nonfermenting diplococci The patient in this vignette is presenting with a history consistent with ectopic pregnancy. Ectopic pregnancy occurs when an egg is fertilized but implants outside of the uterus, most commonly in the fallopian tube. These pregnancies are not viable, but represent a significant health risk to patients. Early on, ectopic pregnancies can present with pain in the lower abdomen or upon micturition with or without low grade fever. Sometimes mild vaginal bleeding episodes can occur due to poor progesterone production by the corpus luteum and therefore withdrawal of the uterine lining. However, late ectopic pregnancies almost always present with significant pain with either vaginal or internal bleeding. They may also be complicated by peritonitis, marked by high-grade fever, excruciating abdominal pain, with rebound tenderness and guarding on abdominal physical exam. One of the main risk factors for ectopic pregnancy is pelvic inflammatory disease (PID). PID causes salpingitis, defined as inflammation of the fallopian tubes, which can lead to scarring if untreated. The scarring of the fallopian tube serves as a nidus for inappropriate implantation of the embryo. The most common cause of PID is untreated infection with either ''Neisseria gonorrhea'', (65% of cases) or ''Chlamydia trachomatis'' (10% of cases). Patients may be remain asymptomatic despite presence of either/both organisms. ''Neisseria gonorrhea'' is a gram-negative maltose-nonfermenting rod which can be treated with ceftriaxone. Due to high prevalence of ''N. gonorrhea'' and ''C. trachomatis'' co-infection, patients with ''N. gonorrhea'' are often also treated with presumable C. trachomatis co-infection with doxycycline.<br/> '''Educational Objective:''' Ectopic pregnancy may be a complication of pelvic inflammatory disease (PID) due to tubal scarring. ''N. gonorrhea'', a gram-negative maltose-nonfermenting rod, is a very common cause of PID<br/> '''References:''' First Aid 2014 page 177 Microbiology William J Gibson (Reviewed by Yazan Daaboul) A 29-year-old sexually active woman presents to the emergency department (ED) with an acute onset of left lower quadrant abdominal pain and chills. She describes the pain as constant and is exacerbated by movement. Her last menstrual period was 8 weeks ago. Her past medical history is significant for tension-type headaches and GERD. Her medications include PRN acetaminophen and daily omeprazole. She denies use of alcohol, illicit drugs, or smoking. Her blood pressure is 118/84 mmHg, heart rate is 92/min, and temperature is 99.7°F (36.7°C). Physical examination is remarkable for left lower quadrant abdominal tenderness with no guarding or rebound tenderness. An initial blood test is immediately sent for analysis; and results are pending. Ultrasound in the ED demonstrates a left adnexal mass. Which of the following organisms most likely predisposed this patient to her current presentation? E Reproductive General Principles Infectious Disease 2020-10-27T23:12:52Z 2459150.4672685 WBR0061