Nonobstructive Acute Renal Failure with a Large Solitary Fibroid

Abstract

A 38-year-old African American woman presenting with acute abdominal pain and nonobstructive renal failure was found to have an enlarged fibroid uterus. A differential for sepsis was considered. Lab evaluation revealed an elevated creatinine and myoglobin level at 3.9 mg/dL and 2140 ng/mL, respectively. Ongoing hemodynamic instability mandated surgery for acute abdomen. A 25 cm fibroid uterus was extirpated through a total abdominal hysterectomy. Immediate improvement of acute nephropathy mirrored the postoperative decline in serum myoglobin levels. Myoglobinemia from a massive degenerating fibroid is associated with nonobstructive acute renal failure.

Figure 1

Computed tomography scan of the abdomen and pelvis without contrast showing the pelvic mass with corresponding solid (arrowhead) and cystic components (arrow). Axial (a), coronal (b), and sagittal (c) views.

Figure 2

Serum myoglobin and creatinine levels during the patient's hospitalization and on the 4-week follow-up.

Figure 3

Hematoxylin and Eosin histologic appearance of the degenerating leiomyoma: (a) complete loss of nuclei from the cells on 10x magnification, (b, c) diffuse infiltrate of polymorphous neutrophils at 10x and 20x, respectively, and (d) stromal hyalinization.