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Streptococcus milleri pyomyoma simulating infective endocarditis
Abstract:
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.
Insights
Infected uterine myomas can be silent, causing persistent fever and bacteremia. This case highlights the importance of considering uterine infections in women with unexplained symptoms and Streptococcus milleri.
Area of Science:
- Gynecology
- Infectious Diseases
- Microbiology
Background:
- Uterine myomas (fibroids) are common, but abscess formation is rare.
- Viridans streptococci, including Streptococcus milleri, can cause serious infections.
Observation:
- A 37-year-old woman presented with fever, anemia, and bacteremia, initially suspected as endocarditis.
- Despite antibiotic treatment for suspected endocarditis, symptoms persisted.
- Laparotomy revealed an abscessed uterine myoma as the source of infection.
Findings:
- Streptococcus milleri was isolated from both the patient's blood and the uterine abscess.
- Clinically occult, abscessed uterine myomas can lead to sustained bacteremia.
- This case underscores the diagnostic challenge posed by silent, infected myomas.
Implications:
- Infected uterine myomas should be considered in the differential diagnosis of unexplained fever and bacteremia, especially with Streptococcus milleri.
- Early recognition and appropriate management of suppurating myomas are crucial.
- Further investigation into the role of Streptococcus milleri in uterine infections is warranted.