Acute Endometritis-Myometritis

Abstract

A middle-aged female patient was admitted to the hospital for delivery of a 27-week estimated gestational age fetus. The fetus was live born and with no acute complications other than being born prematurely. One day later, she developed left-sided facial droop associated with hypertension, tachycardia, chills, cramping, and lower extremity edema. Laboratory testing revealed an elevated white blood cell count, elevated serum urea nitrogen and creatinine levels, and hypoglycemia. The patient was transferred to the intensive care unit but died soon after. As the cause of death was unknown, an autopsy was performed.Even given the short interval between time of death and autopsy and in the background of refrigeration, the body had early decomposition. By internal examination, the uterus was enlarged and diffusely dark red discolored (Figs. 1, 2). Microscopic examination revealed numerous aggregates of bacterial cocci throughout the myometrium, numerous large aggregates of inflammatory cells, which often included apparent immature granulocytes (irregular, slightly lobulated nuclei with a distinct rim of cytoplasm), and numerous eosinophils. Large clusters of more characteristic neutrophils were also identified (Figs. 3,4). Associated with the inflammatory infiltrates was cellular debris. In patches, the myometrium appeared necrotic, with no nuclei visible and with rounded cellular outlines and/or ragged cytoplasm, which was slightly more eosinophilic than expected; however, postmortem change impaired the interpretation. There was no evidence at autopsy of a stroke.