A woman with diabetes presenting with pyomyoma and treated with subtotal hysterectomy: a case report

Abstract

IntroductionPyomyoma (suppurative leiomyoma of the uterus) is a rare condition resulting from infarction and infection of a leiomyoma. It is more usual in pregnant women or postmenopausal women who have vascular disease. The condition is usually fatal unless treated with appropriate antibiotics and surgical intervention.Case presentationWe report a case of a 44-year-old Afro-Caribbean woman with diabetes who presented with recurrent episodes of abdominal pain and fever over a period of five months. Her problem proved to be a diagnostic dilemma mimicking cholecystitis, pyelonephritis and ovarian cancer. Her blood cultures were positive on one occasion for methicillin-resistant Staphylococcus epidermidis. An ultrasound scan suggested uterine fibroids but a computed tomography scan suggested an ovarian malignancy because the mass appeared heterogeneous with fluid filled areas. She was treated with several courses of antibiotics and eventually at laparotomy, she was found to have a large pyomyoma which was successfully removed by subtotal hysterectomy with immediate and complete resolution of her symptoms.ConclusionThe diagnosis of pyomyoma should be considered in perimenopausal women with large fibroids and pyrexia of unknown origin.

Pyomyoma Following Uterine Artery Embolization (UAE) – Dual Case Report and Review of Literature

“…UAE is less invasive than other methods of treatment such as Hysterectomy with similar efficacy and relatively less post treatment complications. A major finding in our reports is that both patients developed pyomyoma post uterine artery embolization however prior reports of pyomyoma associated with uterine artery embolization is rare [4,10]. Absolute contraindications to UAE include viable pregnancy, coagulopathy and active infection due to risk of abscess formation [8].…”

“…Those with hypertension, hyperlipidemia, diabetes, post-partum, immunocompromised and those with a large dominant leiomyoma are at increased risk for the development of pyomyoma [10,14,19]. Though rare, pyomyoma has had other documented links to UAE besides the cases that we presented [4,8,9].…”

“…Other documented links to pyomyoma include intravenous drug abusers [20], presence of intra uterine devices [1], and hypertension especially when combined with hyperlipidemia [21]. Multiple sources have shown an association though not exclusivity of pyomyoma with pregnancy or postmenopausal women who also have underlying vascular disease such as diabetes mellitus and hypertension [1,10].…”

“…A very rare but serious complication known to exist following UAE is that of pyomyoma, a suppurative leiomyoma of the uterus [3,4,[8][9][10]. Pyomyoma (suppurative leiomyoma) results from infarction, necrosis, and infection of the leiomyoma [1,[3][4][5][11][12][13][14][15][16].…”

Successful Myomectomy during Pregnancy for a Large Uterine Fibroid Causing Intestinal Obstruction: Report of a Case

“…Some case series have reported the safety of antepartum myomectomy in carefully selected patients. 4 Also, large uterine fibroids can cause pressure effects which usually manifest itself on the urinary tract (distorting the bladder producing urinary frequency or paradoxically acute retention), ureters (causing hydroureters and hydronephrosis), rectum (causing tenesmus), and veins principally the left common iliac vein (causing varicosities, venous thromboembolism, [12][13] and leg edema). These problems are more likely with large fibroids and renal and venous obstruction are potentially life threatening.…”