A Case Of Staphylococcus lugdunensis Related Pyomyoma Occurring after Cesarean Section

Sir,

Pyomyoma (suppurative leiomyoma) is a rare condition occurring from infarction and infection of a leiomyoma that typically occurs in pregnant women or postmenopausal women who have vascular disease.[1] It can result in complications, such as bacteremia, uterine rupture, and even death.[2] The diagnostic triad of pyomyoma is the following: 1) sepsis; 2) leiomyoma uteri; and 3) no other apparent source of infection.[3]

A 30-year-old female presented with fever and a 6 × 5 cm painful abdominal mass with purulent discharge [Figure 1]. She had fibroids and eight weeks prior to admission, she had an uncomplicated cesarean section. CT revealed pedunculated fibroids, largest measuring 8.6 × 5.9 cm [Figure 2] with secondary degenerative infection. Wound cultures grew Staphylococcus lugdunensis, Staphylococcus epidermidis and Peptostreptococus. She was started on intravenous vancomycin and avelox. At exploratory laparotomy, she was found to have a uterus with pus-filled necrotic fibroids protruding through the abdominal wall. She had a resection of the necrotic fibroids and repair of the abdominal wall. Cultures grew Staphylococcus lugdunensis. She was discharged home one week later.

Figure 1.

Abdominal mass protruding through umbilicus with purulent discharge

Figure 2.

CT scan of abdomen confirming gas in the leiomyoma

S. lugdunensis-related pyomyomas have never been described in the literature and may tend to have a more fulminant course unlike infections caused by other coagulase-negative staphylococci.[4]

A delay in diagnosis may result in fatal complications,[5] which was not the case in our patient who received adequate surgery and broad-spectrum antibiotics that decreased serious morbidity and mortality.