Postoperative Streptococcus constellatus Bacteremia in a 75-Year-Old Patient with Pyometra: A Case Report

Patient: Female, 75-year-old Final Diagnosis: Bacteremia • pyometra Symptoms: Fever • vaginal discharge Medication: — Clinical Procedure: Curettage • drainage Specialty: Infectious Diseases • Obstetrics and Gynecology OBJECTIVE: Unusual clinical course BACKGROUND: Pyometra is an accumulation of pus in the uterine cavity. It is rare in the general population but more common in elderly women. If diagnosed in the early stage, life-threating conditions may be avoided. The most common etiological microorganisms of pyometra are Escherichia coli, Bacteroides species, Staphylococci (eg, epidermidis) and Streptococci. Occasionally, atypical bacteria may be the cause. CASE REPORT: We present the case of a 75-year-old woman, with multiple risk factors, admitted to the Gynecology Department with a 15-day history of yellowish-brown vaginal discharge. Because of rapid enlargement of the uterine cavity, the patient underwent to endometrial curettage. Three hours after surgery, she developed a high-grade fever, and Streptococcus constellatus was isolated in her blood cultures. A specific antibiotic therapy was administered for a total of 14 days, resulting in complete resolution of the infection. CONCLUSIONS: This case report describes a rare case of bacteremia caused by Streptococcus constellatus, that resulted from a pyometra. The classic triad of symptoms (postmenopausal bleeding, vaginal discharge, and lower abdominal pain) may be helpful for diagnosis; however, 50% of patients are asymptomatic. An early recognition of the condition is important to avoid rare but risky consequences, such as perforation of the uterus itself. Nevertheless, surgery can cause dangerous complications such as bacteremia. A different spectrum of bacteria may be involved in the development of pyometra, even in atypical cases, mostly when multiple comorbidities are present. A correct evaluation and management of the patient is essential to guarantee a good prognosis in this rare infection.