Microabscess within adenomyosis combined with sepsis: a report of a rare clinical case

This case study describes a rare presentation of an intermuscular abscess associated with uterine adenomyosis and sepsis, highlighting the diagnostic challenges and clinical management of this condition. A 34-year-old woman presented with severe lower abdominal pain, fever, and a history of recurrent dysmenorrhea, unresponsive to initial antibiotic therapy. Despite unremarkable findings on transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI), blood cultures identified Escherichia coli, confirming a diagnosis of sepsis. Following the failure of conservative treatment, exploratory surgery revealed a uterine abscess related to adenomyosis, necessitating a total hysterectomy. The patient’s postoperative recovery was uneventful, with complete resolution of symptoms and infection. This report emphasizes that patients with adenomyosis presenting with persistent lower abdominal pain and high fever may not respond to antibiotics alone. Rare complications such as abscess formation should be considered, and timely surgical intervention should be pursued when conservative management proves ineffective.