Recurrent pyometra coupled with xanthogranulomatous endometritis mimicking pyelonephritis and malignancy: unravelling clinical complexities

Histiocytic or xanthogranulomatous endometritis (XGE) is an extremely rare benign histopathological entity with only a few cases reported in literature to date. It is characterised by the replacement of endometrial tissue with sheets of foamy histiocytes, giant cells, lymphocytes and plasma cells; calcification and necrosis. It involves chronic inflammation and may be associated with endometrial hyperplasia, endometrial carcinoma and atrophy, causing cervical stenosis and recurrent pyometra, especially in postmenopausal women. We report a case of senile recurrent pyometra masquerading as pyelonephritis clinically and endometrial malignancy radiologically, confirmed later on histology as XGE. Due to deceptive manifestation and rarity of this clinical condition, it is very important for a gynaecologist, radiologist and histopathologist to have a clear understanding of this entity.