Tubo-ovarian abscess (TOA) is a common acute complication of pelvic inflammatory disease (PID). It can also develop as a complication of pelvic or abdominal surgery, malignancy, and intra-abdominal processes such as appendicitis. In premenopausal women, PID is the most common cause of tubo-ovarian abscess. We report a case of tubo-ovarian abscess in a virginal adolescent female with no past surgical history and no known history of appendicitis, inflammatory bowel disease, or cancer. Cultures of the tubo-ovarian abscess drainage grew Abiotrophia/Granulicatella species. This case supports including TOA in the broad differential diagnosis for abdominal pain with fever in adolescent females regardless of sexual history.
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