Painless ruptured pyomyoma causing an abdominal abscess in a postmenopausal woman with abdominal hypoesthesia

Pyomyoma is a rare condition caused by an infection within a uterine leiomyoma. When ruptured, it can cause peritonitis with continuous abdominal pain, potentially leading to life-threatening conditions. However, abdominal pain may be absent in patients with abdominal hypoesthesia. We report a case of painless ruptured pyomyoma causing an abdominal abscess in a 60-year-old woman with abdominal hypoesthesia. The patient with a T4-level sensory deficit due to an acute disseminated encephalomyelitis sequela presented with persistent fever but no abdominal pain. She was initially diagnosed with appendicitis and received antibiotics; however, the inflammatory response and fever persisted. Further investigations revealed a ruptured pyomyoma forming an intra-abdominal abscess. Additional antibiotic administration and extensive surgeries, including hysterectomy, bilateral salpingo-oophorectomy, and ileocecal excision, resolved the severe peritonitis. The postoperative course was uneventful without any relapse. Lack of abdominal pain related to abdominal hypoesthesia can mask the severity of peritonitis.