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Pyomyoma after uterine instrumentation. A case report
D H Tobias1, M Koenigsberg, M Kogan
1Department of Obstetrics and Gynecology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10461, USA.
Background:
Since 1945, only 10 cases of pyomyoma have been described in the literature. Four were related to pregnancy but none to elective abortion or uterine instrumentation.
Case:
A 32-year-old woman was admitted to the hospital with a history of lower abdominal pain, nausea, vomiting and low grade fever with a past medical history significant for uterine leiomyomata and a second-trimester elective abortion 10 weeks prior to admission. Pelvic sonography demonstrated an enlarged uterus with a mass consisting of cystic and solid components. Uterine curettage revealed blood clots and scanty endometrial tissue. After no improvement following antibiotic therapy and nondiagnostic uterine curettage, an exploratory laparotomy was performed. It revealed peritonitis with multiple pyomyomas draining purulent material.
Conclusion:
Although rarely reported, pyomyoma should be considered in the setting of a recent history of uterine instrumentation, signs of infection and a uterine myoma.
