A 27-year-old female presented to the emergency department with fevers, nausea, chills, and non-specific bilateral lower quadrant abdominal pain. A pregnancy test was negative. Computed tomography demonstrated moderate left hydronephrosis secondary to tubo-ovarian abscess. The abscess was so large it distorted local anatomy and compressed the ureters. She was prescribed meropenem and admitted for care by obstetrics/gynecology.