title: Postnatal pyomyoma: a diagnostic dilemma.
abstract: Pyomyoma is a rare, yet potentially fatal complication of uterine leiomyoma. Clinically difficult to diagnose as a result of non-specific symptoms, its presentation is commonly confused with fibroid degeneration. Late diagnosis has severe implications, with the mortality of the condition remaining high. Despite the availability of powerful antibiotics, surgical intervention is frequently required for the curative treatment of the critically ill patient. Here, we report a case of postpartum pyomyoma developing after a complicated antenatal course of placenta praevia resulting in recurrent antepartum haemorrhage, preterm prelabour rupture of membranes and eventual emergency caesarean section for cord prolapse. We highlight the diagnostic difficulty and delay in definitive surgical intervention. Using this case, we have emphasised the importance of strong clinical suspicion when faced with a triad of pain, sepsis without an obvious source and a known diagnosis of leiomyoma to prevent fatalities.
authors.affiliation: Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK.
authors.forename: Ravneet
authors.initials: R
authors.lastname: Sirha
authors.forename: Aditi
authors.initials: A
authors.lastname: Miskin
authors.forename: Amin
authors.initials: A
authors.lastname: Abdelmagied
mesh_terms: D000328:Adult; D002585:Cesarean Section; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007231:Infant, Newborn; D007889:Leiomyoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D010923:Placenta Previa / Q000000981:diagnostic imaging / Q000601:surgery; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging / Q000473:pathology*; D011295:Prenatal Care / Q000379:methods; D055112:Pyometra / Q000175:diagnosis* / Q000601:surgery*; D035583:Rare Diseases; D018570:Risk Assessment; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014594:Uterine Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*