Pyomyoma outside of pregnancy—Case report and systematic review of the literature

Abstract

Background

Pyomyoma is a rare but potentially life‐threatening phenomenon with a high mortality rate reaching up to 20%–30%. It can present in women during the antenatal or postpartum period as well as after uterine artery embolization or even spontaneously. Common presenting symptoms include abdomino‐pelvic pain and fever in the presence of uterine leiomyoma.

Objectives

To assess the different presentations of pyomyoma in a non‐pregnant population, and review the treatment modalities.

Search Strategy

This systematic review was conducted following the PRISMA guidelines. We performed a comprehensive search of PubMed, Scopus, Google Scholar and Embase during the years 1945–2024.

Selection Criteria

Included case reports assessed the types of intervention (hysterectomy, myomectomy, or other forms of treatments) to treat pyomyoma. All case studies confirming diagnosis of pyomyoma on either operative and/or histologic findings were eligible.

Data Collection and Analysis

A total of 121 studies were initially screened and after a full text evaluation, 52 articles were included in this systematic review.

Main Results

Pyrexia and abdominal pain were the commonest presenting symptoms found in 72% and 57% of patients, respectively. The most common causative organism was E‐coli (23%). A total of 61% of patients underwent hysterectomy, and 27% patients had a myomectomy performed. A total of 12% of patients were treated with conservative management.

Conclusions

Given the considerable mortality risk of approximately 20%–30%, the benefits of surgical treatment tend to outweigh the potential risks. Where future fertility is a concern, it may be possible to eliminate the source of infection by performing myomectomy instead of hysterectomy in conjunction with antimicrobials.