•We present a case of rupture pyomyoma causing severe sepsis in a postmenopausal woman.

 

•Pyomyoma is a rare complication stemming from infarction due to vascular disease and infection due to bacterial seeding from direct, haematogenous or lymphatic spread.2

•Our patient had risk factors of diabetes and hypertension, which may have led to ischaemia, necrosis and subsequent seeding from the vaginal flora.

•The history of fibroid and the acute presentation were key to diagnosis.

•Our patient made a complete recovery due to timely management of sepsis and surgery.

•There have been published case reports of pyomyoma but so far none have reported spontaneous rupture of pyomyoma in a postmenopausal woman.

•While most cases present with acute or subacute symptoms, pyomyomas may present with vague chronic symptoms which make it difficult to distinguish from a malignant tumour in a postmenopausal woman.

•The presence of gas within the fibroid on a CT scan is a pathognomonic feature of pyomyoma. However, even in the absence of this, pyomoma must be suspected in a patient with a history of fibroid, sepsis and unidentified source of infection. 

•The gold standard treatment is hysterectomy. Mortality rate depends on the treatment modality, with 40% antibiotic alone and 2.5% with hysterectomy. 1

•Ruptured pyomyoma is a complication of pyomyoma which could cause septic shock.

•Currently there is no guideline on managing pyomyoma, therefore further research is recommended to allow evidence-based practice.

•We are grateful  for our patient for agreeing to share her story so gynecologists could learn, and patients  receive the optimal care they deserve.

•I also thank my supervisor Miss Tamhankar for her continuous academic support.