Eosinophilic perifolliculitis presenting as a painful cystic ovarian mass in a woman with fibromyalgia: a case report.
BACKGROUND
Autoimmune oophoritis is characterized by an ovarian lymphocytic infiltrate and is a rare finding in women with premature ovarian failure. Eosinophilic perifolliculitis is a possible variant of autoimmune oophoritis, of which the pathogenesis and natural history are largely unknown.


METHODS
A 45-year-old woman, gravida 2, para 2, status post total abdominal hysterectomy, presented to her internist complaining of cyclic, throbbing, right lower quadrant pain. Her past medical history was significant forfibromyalgia. Pelvic ultrasound demonstrated a 2.3-cm, physiologic-appearing right ovarian cyst. Follow-up ultrasound showed a 2.2-cm, complex cyst on the right ovary that increased in size to 4.2 x 3.2 x 3.5 cm on repeat ultrasound 12 weeks later. Exploratory laparotomy and bilateral salpingo-oophorectomy were performed. Pathologic evaluation of the ovaries revealed a 3 x 2 cm regressing corpus luteal cyst with numerous eosinophils, lymphocytes, macrophages and plasma cells, infiltrating the cyst zoall. Serum antiovarian antibodies were positive.


CONCLUSIONS
The patient's pathologic findings are consistent with the rare entity of eosinophilic perifolliculitis. The patient's history offibromyalgia is of particular interest given that both of these diseases may have an autoimmune etiology. Eosinophilic perifolliculitis should be considered in the differential diagnosis of premenopausal and perimenopausal women with pelvic pain and persistent cystic ovarian enlargement.
Department of Obstetrics and Gynecology, Women & Infants' Hospital and Brown Medical School, Providence, Rhode Island 02905-2499, USA.
Kristen
K
Page
Kelly
K
Pagidas
Mary C
MC
Derosa
M Ruhul
MR
Quddus
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000276:immunology; D003338:Corpus Luteum / Q000378:metabolism; D004802:Eosinophilia / Q000175:diagnosis / Q000276:immunology*; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis* / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008875:Middle Aged; D009869:Oophoritis / Q000175:diagnosis / Q000276:immunology*; D010048:Ovarian Cysts / Q000175:diagnosis* / Q000601:surgery; D010052:Ovariectomy / Q000379:methods; D010147:Pain Measurement; D035583:Rare Diseases; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome