Urticaria associated with necrotic uterine leiomyomas infected with salmonella

We describe a unique case of urticaria associated with a Salmonella infection of uterine leiomyomas.

A 55-year-old woman with a known history of uterine leiomyomas and a chief complaint of recurrent small and coalescing urticarial lesions confined to the abdomen presented with an 18-year history of recurrent fever and flu-like symptoms associated with the urticaria. After confirming the presence of a leiomyoma containing necrotic tissue on the computed tomography scan, a hysterectomy was performed. A large, 11-cm intramural leiomyoma was removed, and a culture of the purulent content grew a previously untyped Salmonella. The urticaria resolved on removal of the necrotic tissue. Subsequent follow-up for more than 2 years shows no relapse of symptoms.

Our patient harbored Salmonella bacteria in a necrotic uterine leiomyoma, where it was difficult to detect until the time of surgery. In patients presenting with localized urticaria of the abdomen, an infection in the pelvic and abdominal tissue should be considered in the differential diagnosis.