Pyomyoma in a patient with end-stage renal disease and poorly controlled diabetes: A rare cause of acute abdomen diagnosed by CT

Pyomyoma, or suppurative leiomyoma, is a rare and potentially life-threatening complication of uterine fibroids, usually occurring in postpartum or immunocompromised women. We report a 52-year-old postmenopausal woman with end-stage renal disease on hemodialysis and poorly controlled diabetes mellitus who presented with high-grade fever and diffuse abdominal pain. Contrast-enhanced computed tomography revealed a large heterogeneous uterine mass with central liquefactive necrosis, intratumoral gas, and peripheral enhancement, consistent with pyomyoma. Total hysterectomy confirmed a suppurative leiomyoma with <i>Escherichia coli</i> infection. The patient achieved full recovery following surgery and antibiotic therapy. This case highlights the diagnostic value of CT in detecting pyomyoma before rupture and emphasizes the importance of early recognition and timely surgical intervention in immunocompromised patients.