title: Pyomyoma in a premenopausal woman with fever of unknown origin.
abstract: BACKGROUND
  Pyomyoma (suppurative leiomyoma) is a rare disease that is a serious complication. Most cases have occurred in pregnant or postmenopausal women.
  
  
  METHODS
  A perimenopausal woman presented with fever and shoulder pain. She had no predisposing factors or history of leiomyoma. Ultrasonographic as well as abdominal and pelvic computed tomography scans showed an enlarged uterus with two large masses. Internal heterogeneous echogenicity was noted in the lower segment and body of the uterus. The elevated temperature continued despite a 3-day antibiotic course of clindamycin, ceftriaxone, and gentamicin. With a clinical impression of infected leiomyoma, she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pathological findings showed a leiomyoma with abscess formation. The patient responded well to surgery.
  
  
  CONCLUSIONS
  Pyomyoma may be difficult to diagnose, especially in women with a nonspecific clinical presentation. Delayed diagnosis may result in serious complications, and surgery and broad spectrum antibiotics are indicated.
authors.affiliation: From the Department of Infectious Diseases, Islamic Azad University, Tehran Medical Branch, Tehran, Iran; the Department of Endocrinology and Female Infertility, Royan Institute for Reproductive Biomedicine, Tehran, Iran; Erfan Hospital, Tehran, Iran; the Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran; the Department of Pathology, Islamic Azad University, Tehran Medical Branch, Tehran, Iran; and the Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran.
authors.forename: Mehrangiz
authors.initials: M
authors.lastname: Zangeneh
authors.forename: Azam
authors.initials: A
authors.lastname: Alsadat Mahdavi
authors.forename: Elham
authors.initials: E
authors.lastname: Amini
authors.forename: Seyed
authors.initials: S
authors.lastname: Davar Siadat
authors.forename: Leila
authors.initials: L
authors.lastname: Karimian
mesh_terms: D000038:Abscess / Q000382:microbiology / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002954:Citrobacter; D004756:Enterobacteriaceae Infections / Q000150:complications* / Q000382:microbiology; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007889:Leiomyoma / Q000382:microbiology / Q000628:therapy*; D008875:Middle Aged; D017697:Premenopause; D014594:Uterine Neoplasms / Q000382:microbiology / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents