Postpartum pyomyoma due to Mycoplasma hominis: A case report

Abstract

Pyomyoma is a rare condition that causes fever and abdominal pain associated with pregnancy, especially in the postpartum period. An appropriate diagnosis and early medical intervention are required to prevent serious complications. A 38-year-old primigravida with uterine fibroids had fever from the 11th day after cesarean section. The fever did not resolve despite repeated daily administration of broad-spectrum β-lactam antibiotics for 2 weeks. Although the physical examination did not show any lower abdominal pain, a pelvic magnetic resonance scan revealed degenerative fibroids, and myomectomy was performed. Yellow-greenish odorless pus inside the uterus was detected, and Mycoplasma hominis was detected in the pus culture. Mycoplasma species are resistant to broad-spectrum penicillin antibiotics and can cause pyomyoma. Pyomyomas may not cause uterine tenderness, and the causative organism may be difficult to identify; therefore, additional imaging studies should be considered.

Keywords: CS, cesarean section; CT, computer tomography; DWI, diffusion-weighted image; Degenerative fibroid; MRI, magnetic resonance imaging; Mycoplasma hominis; Postpartum fever; Pyomyoma; US, ultrasonography.

Fig. 1

Clinical course and change in body temperature, white blood cell (WBC) levels, and C-reactive protein (CRP) levels. 4.5 g of tazobactam/piperacillin (1:4; TAZ/PIPC) was administered intravenously three times daily. Blood urine, urine, and vaginal discharge culture were taken on the 16th and 20th postoperative days. The myomectomy resolved the patient's fever when WBC and CRP diminished to normal ranges.

Fig. 2

Magnetic resonance images: axial T2-weighted (A), T1-weighted (B), sagittal T2-weighted (C), and sagittal T1-weighted (D). Degenerated fibroid with ring-shaped high signal around fibroid in the T1-weighted image.

Fig. 3

Intraoperative photographs. A) Yellowish pus bulging into the incision line. B) A degenerative myoma is enucleated with traction through the uterine incision.