A rare case of fulminant sepsis secondary to postpartum pyomyoma caused by Prevotella bivia: a case report

Pyomyoma is rare but can cause life-threatening sepsis from uterine leiomyoma infection. Curative radical surgery to completely remove all infectious foci is preferable if conservative treatment fails, but for patients with fertility concerns, alternatives to uterine removal should be considered. The author reports a case of postpartum pyomyoma to remind clinicians of this rare disease and the need for rapid intervention to preserve patient fertility. CASE PRESENTATION: A postpartum female with a fever of unknown origin was admitted to a public hospital. The patient’s general condition rapidly worsened, and surgical removal of the pyomyoma was assumed to be necessary for controlling the infection source. The patient initially refused surgery, as she had fertility concerns; however, she developed septic shock and acute respiratory distress syndrome. Subsequently, surgical intervention was considered imperative, and the patient consented to surgery. Normal uterus was carefully differentiated from degenerated intramural pyomyoma, and the endometrium remained intact. In the pyomyoma specimen, Prevotella bivia, an endogenous anaerobic bacterium that can colonize the lower genital tract, was detected. CLINICAL DISCUSSION: For patients with postpartum sepsis and leiomyoma, pyomyoma should be considered, even if the patient is immunocompetent and has no risk factors. Pyomyoma can be exacerbated into a fulminant and fatal course after subacute, insidious progression. CONCLUSION: Comprehensive treatment strategies, including source control of infection and uterine preservation, are required for future fertility. Strict vigilance and appropriate and prompt surgical intervention when conservative treatments fail are crucial to save the patient and preserve fertility.