Pyomyoma after caesarean section: a rare entity

Pyomyoma, a rare complication of a myoma undergoing infarction and subsequent infection, may be a diagnostic challenge in patients with unexplained puerperal fever. A woman in her 30s presented with fever and foul-smelling discharge per vaginum, 6 months after her first caesarean section (CS). She underwent an elective CS for symptomatic placenta praevia at 34 weeks of gestation. Intra-operatively, post-partum haemorrhage was managed with uterotonics and blood transfusions. However, 2 weeks later, she developed a high-grade fever that was non-responsive to parenteral antibiotics. She continued to have intermittent episodes of high-grade fever, which were treated on an outpatient basis. Six months later, she developed purulent vaginal discharge, which grew Escherichia coli on bacterial culture. She received intravenous antibiotics and blood. Radiology confirmed the presence of a large fibroid with a focal capsular breach and peripherally enhanced collection extending to the endometrial cavity. The patient subsequently underwent a myomectomy. Intra-operatively, a large fundal myoma with endometrial breach and purulent discharge in the fibroid and endometrial cavity was noted. She sustained the procedure well and recovered uneventfully.