An elderly woman with Prevotella bacteraemia secondary to pyometra

Abstract

An 87-year-old woman was admitted to our hospital with sepsis and foetid vaginal discharge. She presented an abdominal mass that had been present for the last 20 years, refused diagnostic or therapeutic procedures. A computed tomography scan detected a uterine body with multiple calcifications and an internal collection of 10 cm. No other infectious sources were apparent. A tentative diagnostic of pyometra was made and empiric antibiotic treatment was initiated. A hysteroscopy was performed with incomplete drainage of purulent material, due to important vaginal atrophy. In both blood and vaginal fluid cultures Prevotella spp. was isolated. Clinical evolution was favourable with metronidazole. The patient refused a hysterectomy or other surgical drainages, and she was discharged from hospital with oral antibiotics. The patient underwent antibiotic therapy during 1 month; 1 week after finishing this treatment, the patient died. The characteristics of clinical evolution in these last days were not known.

Figure 1

Abdominal x-ray showing a calcified mass in the lower abdomen.

Figure 2

Computed tomography scan—coronal.

Figure 3

Computed tomography scan—axial. A large calcified myoma, with an intrauterine heterogeneous liquid collection of about 10 cm in diameter without an air–fluid level; pneumoperitoneum is absent.