Ruptured uterine pyomyoma with multiorgan dysfunction syndrome

A woman with a history of chronic hypertension, no previous pregnancies and a recent myomectomy presented to the emergency department with fever, vomiting, diarrhoea and abdominal pain. She showed signs of septic shock, acute kidney injury and respiratory failure. Imaging revealed a large necrotic fibroid, hydrosalpinx, ascites and pleural effusion. Blood cultures showed Escherichia coli growth. She underwent emergency surgery for total abdominal hysterectomy, bilateral salpingoophorectomy and hysteroscopy. Intraoperatively, purulent discharge was found, and cultures confirmed E. coli infection. Pathology revealed leiomyomata with degenerative changes, benign endometrial polyps and endometriosis. Postoperatively, she received intensive care and showed gradual improvement, eventually being discharged in a stable condition. Follow-up appointments showed resolution of symptoms, wound healing and no infection recurrence. Antibiotics were discontinued, and the pleural drain was removed. Overall, the patient had a successful recovery with no complications noted during follow-up.