Uterine preservation in pyomyoma complicating uterine artery embolisation

Pyomyoma, a rare complication of uterine artery embolisation (UAE) for symptomatic fibroids, can closely mimic post-embolisation syndrome (PES), which typically presents with pain, fever and leucocytosis within the first week. Differentiating PES from pyomyoma is critical, as pyomyoma carries a higher risk of severe complications. We report a case of an unmarried nulliparous woman who developed pyomyoma following UAE for fibroids. Initially suspected to have PES, her persistent high-grade fever, purulent discharge and imaging findings of gas pockets within a necrotic fibroid led to the diagnosis of pyomyoma. Despite initial treatment with broad-spectrum antibiotics, emergency laparotomy was required, revealing a necrotic, pus-filled fibroid. The infected tissue was excised, and careful surgical reconstruction of the uterus was performed, successfully preserving her fertility. This case underscores the importance of timely intervention and uterine-preserving approaches in patients with prolonged or worsening symptoms after UAE to optimise both clinical and reproductive outcomes.