Ruptured uterine pyomyoma with multiorgan dysfunction syndrome

A woman with a history of chronic hypertension, no previous pregnancies and a recent myomectomy presented to the emergency department with fever, vomiting, diarrhoea and abdominal pain. She showed signs of septic shock, acute kidney injury and respiratory failure. Imaging revealed a large necrotic fibroid, hydrosalpinx, ascites and pleural effusion. Blood cultures showed <i>Escherichia coli</i> growth. She underwent emergency surgery for total abdominal hysterectomy, bilateral salpingoophorectomy and hysteroscopy. Intraoperatively, purulent discharge was found, and cultures confirmed <i>E. coli</i> infection. Pathology revealed leiomyomata with degenerative changes, benign endometrial polyps and endometriosis. Postoperatively, she received intensive care and showed gradual improvement, eventually being discharged in a stable condition. Follow-up appointments showed resolution of symptoms, wound healing and no infection recurrence. Antibiotics were discontinued, and the pleural drain was removed. Overall, the patient had a successful recovery with no complications noted during follow-up.