Group A Strep Pyomyoma Rapidly Causes Septic Shock in a Non-Gravid Female

Viviana de Assis DO, Neil Phippen and Larissa Weir

Department of Obstetrics and Gynecology, San Antonio Military Medical Center, USA
Department of Gynecology Oncology, San Antonio Military Medical Center, USA

^*Correspondance to: Viviana de Assis DO 

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Abstract:

Background: Pyomyoma is a rare complication of leiomyoma, presenting with a triad of sepsis, leiomyoma and no other source of infection that can lead to death or significant morbidity if left untreated. Risk factors for pyomyoma include uterine tampering with intra uterine device placement, dilation and curettage, uterine artery embolization, hysteroscopy, or pregnancy inclusive of a birth event. We present a case of a spontaneous group A strep pyomyoma in a non-gravid otherwise healthy female, with no risk factors, manifesting as septic shock. Case: A 39 yrs G1P1 presented to the emergency department in septic shock after one day of severe abdominal pain. Her history was remarkable for abnormal uterine bleeding without prior uterine surgery or therapy. Act of the abdomen and pelvis revealed massive enlargement of the uterus. She was admitted in septic shock secondary to a streptococcus pyogenes bacteremia. Despite initial medical stabilization with fluid resuscitation, vasoactive agents, and antibiotic coverage, she remained febrile with pronounced tenderness of her abdominopelvic mass. An exploratory laparotomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy for a pyomyoma were completed. Her post-operative course was uncomplicated and notable for rapid resolution of her septic course.
Conclusion: Spontaneous group A strep pyomyoma formation in a patient without risk factors has not been reported in the literature. Our case of an abrupt onset group A strep septic shock from a pyomyoma in a patient with no known risk factors highlights the importance of early recognition and aggressive surgical management, which can be lifesaving.

Keywords:

Pyomyoma; Septic shock; Sepsis

Cite the Article:

Viviana de Assis DO, Phippen N, Weir L. Group A Strep Pyomyoma Rapidly Causes Septic Shock in a Non-Gravid Female. Clin Case Rep Int. 2019; 3: 1086.