Pelvic inflammatory disease with severe, acute, life threatening manifestations is rare among perimenopausal, middle- aged and advanced reproductive aged women. We report a case of a 46-year old perimenopausal window from a low socio-economic background with multiple sexual partners who presented with severe lower abdominal pain, vaginal discharge and fever of seven, six and four days duration respectively. These were associated with vomiting, frequent stooling and generalized body weakness. Physical examination revealed an acutely ill middle aged woman, febrile (temperature – 38.70c), dehydrated, in painful distress with inability to walk erect. After systemic examination, diagnosis of severe acute pelvic inflammatory disease (PID) was made and this was confirmed with laboratory and radiological investigations. She was admitted, resuscitated and treated with relevant antibiotics and other supportive measures, with good outcome. She was subsequently educated and counseled appropriately before discharge and follow up. We conclude that though acute PID is rare among middle aged women, sporadic cases abound and high index of suspicion, prompt evaluation and treatment to avert mortality is recommended. Risk factors should be identified and addressed appropriately too.
