Necrotic leiomyoma and gram-negative sepsis eight weeks after uterine artery embolization.
BACKGROUND
Uterine artery embolization for symptomatic leiomyomata is generally safe, but rare life-threatening complications, including sepsis, can result.


METHODS
A 39-year-old woman with primary antiphospholipid syndrome, who was on chronic warfarin therapy, underwent uterine artery embolization for severe menorrhagia and a 12-cm intracavitary leiomyoma. Eight weeks postembolization, the patient, who had been essentially asymptomatic, presented in septic shock from gram-negative anaerobic bacteria. She underwent hysterectomy and bilateral salpingo-oophorectomy for a large infarcted necrotic leiomyoma and partial uterine necrosis. The patient's 8-day hospitalization required extended care in the intensive care unit and blood transfusion and resulted in surgical menopause in a patient who is not a candidate for hormone therapy.


CONCLUSIONS
Uterine artery embolization is a procedure not without significant risks. From published case reports, it appears that patients most at risk for severe infection of an infarcted leiomyoma after this procedure are those with a large dominant leiomyoma.
Aungst
Matthew
M
Department of Obstetrics and Gynecology, David Grant Medical Center, Travis Air Force Base, California, USA. Mathew.aungst@60mdg.travis.af.mil
Wilson
Mark
M
Vournas
Karen
K
McCarthy
Sarah
S
D000328:Adult; D000900:Anti-Bacterial Agents; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007262:Infusions, Intravenous; D007889:Leiomyoma / Q000473:pathology / Q000628:therapy*; D009336:Necrosis / Q000473:pathology; D010052:Ovariectomy / Q000379:methods; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology / Q000628:therapy*
D000900:Anti-Bacterial Agents