A 14-year-old female was seen for acute abdominal, back, and flank pain, accompanied with dysuria, increased frequency of urination, nausea, and decreased appetite. After an initial diagnosis of pyelonephritis, a presumptive diagnosis of pelvic inflammatory disease (PID) was made. The cervical culture was positive for Chlamydia trachomatis and a pelvic sonogram demonstrated abnormal right adnexal structures and a possible mass. Exploratory laparotomy was performed, which demonstrated right-sided inflammation in the fimbria and fallopian tube as well as an ovarian cyst on the right. Her postoperative course was uncomplicated and was continued on oral doxycycline.