Pyomyoma in a Perimenopausal Woman with Intrauterine Device

Abstract

Pyomyoma (suppurative leiomyoma) is a rare disease, which is considered to be a serious complication of uterine leiomyoma. Since 1945, only 18 patients have been reported and ours is the 19th. Although it is frequently reported in pregnant women or postmenopausal women who have vascular disease, our case is a 42-year-old woman in the perimenopausal period who presented with fever and a tender lower abdominal mass. She used the intrauterine device as a contraceptive method but leiomyoma had never been found before. Ultrasonographic findings suggested an ovarian tumor. She was diagnosed as having infected malignant ovarian cancer with an elevated CA 125 level that was initially treated with broad spectrum antibiotics; then she underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pathological findings showed acute and chronic inflammation of the endometrium with abscess formation in an intramural leiomyoma. The intrauterine device might be the origin of pyomyoma due to a direct spread of the infection from the uterine cavity. Pyomyoma may be difficult to diagnose especially in those with a nonspecific clinical presentation without any history of leiomyoma. Delayed diagnosis may result in serious complications, whereas adequate surgery and broad spectrum antibiotics may decrease serious morbidity and mortality.

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

“…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].…”

“…Leiomyomas of the uterus, or more commonly fibroids, are benign tumors of the smooth muscle of the uterus [1]. A substantial number of women have fibroids, some studies show 70% occurrence in white women and 80% occurrence in black women by the age of 50 [2,3].…”

“…Pyomyoma (suppurative leiomyoma) results from infarction, necrosis, and infection of the leiomyoma [1,[3][4][5][11][12][13][14][15][16]. Pyomyoma is a rare occurrence in the post-antibiotic era.…”

Magnetic resonance imaging and positron emission tomography of a giant multiseptated pyomyoma simulating an ovarian cancer

“…The diagnosis is difficult because of its insidious presentation and the lack of reported images and specific clinical findings. Previous reported images were a few sonographic findings and only two CT findings (1)(2)(3)(4). In the present case report, we describe the MRI and PET findings of a huge pyomyoma.…”

Myometrial Abscess: A Complication of Myomectomy of a Large Lower-Uterine Segment Myoma

“…Since 1945, only 19 cases have been reported. 1 Pyomyoma usually develops in association with either recent pregnancy or in postmenopausal patients who frequently have underlying vascular disease. The triad of: (1) bacteremia or sepsis (2) leiomyoma uteri and (3) no other apparent source of infection should suggest the diagnosis of pyomyoma.…”