A Rare Case of Idiopathic Pyometra in a Premenopausal Patient
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Pyometra is a very uncommon disease principally occurring in postmenopausal women. It is characterized by the accumulation of purulent material within the uterine cavity. This paper presents the clinical history of a 35-year-old premenopausal woman with otherwise normal menstruation who developed heavy menstruation and was diagnosed with a benign pyometra of indeterminate etiology in March 2017. The patient underwent repeated ultrasound-guided drainage, dilation and curettage, and antibiotic therapy. Biopsies of the pelvic sidewall revealed endometriosis in June 2017. The heavy menstruation and suppurative fluid in the uterus of the patient persisted in which intramuscular leuprolide acetate was prescribed to address the endometriosis and heavy menstrual bleeding. Ultimately, the leuprolide acetate effectively resolved the patient’s bleeding and pyometra. The medication was concluded after 12 months of supervision and the patient is currently symptom free. Pyometra is an unusual condition rarely identified in premenopausal women. Drainage and antibiotic therapy are routinely employed; however, one may consider gonadotropin-releasing hormone agonist medication to potentially confer a beneficial patient outcome in rare cases where endometriosis and bleeding are intractable.
Abstract
Pyometra is a very uncommon disease principally occurring in postmenopausal women. It is characterized by the accumulation of purulent material within the uterine cavity. This paper presents the clinical history of a 35-year-old premenopausal woman with otherwise normal menstruation who developed heavy menstruation and was diagnosed with a benign pyometra of indeterminate etiology in March 2017. The patient underwent repeated ultrasound-guided drainage, dilation and curettage, and antibiotic therapy. Biopsies of the pelvic sidewall revealed endometriosis in June 2017. The heavy menstruation and suppurative fluid in the uterus of the patient persisted in which intramuscular leuprolide acetate was prescribed to address the endometriosis and heavy menstrual bleeding. Ultimately, the leuprolide acetate effectively resolved the patient’s bleeding and pyometra. The medication was concluded after 12 months of supervision and the patient is currently symptom free. Pyometra is an unusual condition rarely identified in premenopausal women. Drainage and antibiotic therapy are routinely employed; however, one may consider gonadotropin-releasing hormone agonist medication to potentially confer a beneficial patient outcome in rare cases where endometriosis and bleeding are intractable.
참고문헌 (15)
- Muram D, "Pyometra", Can Med Assoc J, 125, pp.589~592 (1981)
- Chan LY, "What is its clinical significance?", J Reprod Med, 46, pp.952~956 (2001)
- Kerimoglu OS, "Pyometra in elderly post-menopausal women : a sign of malignity", Eur J Gynaecol Oncol, 36, pp.59~61 (2015)
- Imachi M, "Spontaneous perforation of pyometra presenting as generalized peritonitis in a patient with cervical cancer", Gynecol Oncol, 50, pp.384~388 (1993)
- Akazawa K, "Clinico-statistical study on pyometra in high-aged outpatients", Nihon Sanka Fujinka Gakkai Zasshi, 43, pp.1539~1545 (1991)
- Batioglu S, "Endoscopic management of a case of complete septate uterus with unilateral pyometra", Gynecol Obstet Invest, 47, pp.144~146 (1999)
- Carter B, "A bacteriologic and clinical study of pyometra", Am J Obstet Gynecol, 62, pp.793~805 (1951)
- Lui MW, "Clinical significance of pyometra", J Reprod Med, 60, pp.329~332 (2015)
- Chaopotong P, "Spontaneous perforation of pyometra in an elderly woman : a case report", J Med Assoc Thai, 95, pp.723~736 (2012)
- Kumar P, "Gonadotropin-releasing hormone analogs : understanding advantages and limitations", J Hum Reprod Sci, 7, pp.170~174 (2014)
- Whirledge S, "Glucocorticoids, stress, and fertility", Minerva Endocrinol, 35, pp.109~125 (2010)
- Liu YT, "Clinical analysis of pelvic abscess with endometriosis", Zhonghua Fu Chan Ke Za Zhi, 52, pp.164~167 (2017)
- Gobello C, "Dopamine agonists, anti-progestins, anti-androgens, long-term-release GnRH agonists and anti-estrogens in canine reproduction : a review", Theriogenology, 66, pp.1560~1567 (2006)
- Camisa C, "Treatment of hidradenitis suppurativa with combination hypothalamic-pituitary-ovarian and adrenal suppression", J Reprod Med, 34, pp.543~546 (1989)
- Malvadkar SM, "Spontaneous rupture of pyometra causing peritonitis in elderly female diagnosed on dynamic transvaginal ultrasound", Case Rep Radiol, 2016, pp.1738521~ (2016)