Streptococcus milleri pyomyoma simulating infective endocarditis

A 37-year-old woman with clinically occult, abscessed uterine myomas presented with fever, anemia, splenomegaly, and viridans streptococcal bacteremia. An initial diagnosis of endocarditis was made, but fever persisted despite appropriate antibiotics. Pelvic pain evolved and laparotomy revealed an infected myoma. Streptococcus milleri was isolated from both the blood and the uterine abscess. Infected uterine myomata may be clinically silent despite producing sustained bacteremia. The occurrence of suppurating myomas and the significance of S milleri isolates are briefly reviewed.