An Unusual Cause Of Abdominal Pain In A Post-menopausal Woman With Advanced Cancer | 50589
Journal of Infectious Diseases & Therapy
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A 67-year-old post-menopausal woman with advanced stage histiocytic sarcoma of the pelvis, presented with 4-day history of
abdominal pain and fever. She had local tumor invasion to bladder and cervix requiring bilateral percutaneous nephrostomy
tubes. She received chemotherapy and radiotherapy with partial tumor regression. On examination she had an enlarged suprapubic
mass and foul-smelling vaginal discharge. A computed tomography (CT) scan demonstrated a large cervical mass occluding the
cervical os, causing dilatation of the endometrial cavity, doubling its size compared to one month prior. The patient was started in
broad spectrum antibiotics and a cervical catheterization was intended unsuccessfully. A CT guided percutaneous uterine drain was
placed in her abdomen and purulent drainage grew Prevotella loescheii. Blood and urine cultures were negative. She was discharged
under oral sulfamethoxazole/trimethoprim and metronidazole with clinical improvement. In the subsequent months she underwent
chemotherapy and radiotherapy and required long-term percutaneous drainage. Pyometra is defined as the accumulation of pus in the
uterine cavity and thought to be a result of interference with the natural drainage of the uterus. Symptoms are non-specific and easily
misdiagnosed. Diagnosis can be made clinically by drainage of pus from the uterine cavity and with imaging. Treatment includes
drainage along with antibiotics to cover microorganisms such as Lactobacillus iners, Prevotella spp., and Lactobacillus crispatus. Vague
abdominal symptoms in a post-menopausal woman with pelvic malignancy should raise concern for pyometra and prompt treatment
has to be instituted to prevent the development of the most catastrophic complication; uterine perforation.
Gabriela Sanchez Petitto has completed her MD from the Universidad Central de Venezuela, School of Medicine. She is currently a Postgraduate student of Internal Medicine at the University of Texas Health Science Center at Houston. She has worked in several projects with hematological malignancies and in the upcoming future with antibiotic resistance projects.