Early-onset pyomyoma mimicking post-embolization syndrome after uterine artery embolization: a case report and review of the literature

Introduction: Pyomyoma is a rare but potentially severe complication of uterine fibroids, often presenting with nonspecific symptoms that complicate diagnosis. We report a case of early-onset pyomyoma occurring in the immediate post-procedural period following uterine artery embolization (UAE). Case presentation: A 53-year-old woman with a history of uterine fibroids underwent emergent UAE for abnormal uterine bleeding due to a cervical polyp, despite prior cervical polypectomy. Two days after the procedure, she developed high-grade fever and chills. Post-embolization syndrome was initially suspected. Blood cultures grew extended-spectrum β-lactamase–producing Escherichia coli. Despite appropriate antimicrobial therapy, her condition did not improve. Computed tomography of the abdomen revealed intralesional gas within a uterine fibroid, prompting an abdominal hysterectomy for source control. Histopathological examination revealed abscess formation extending from the endometrium to the myometrium, confirming the diagnosis of pyomyoma. The patient's symptoms resolved promptly after surgery. Conclusion: This case highlights the importance of recognizing early-onset pyomyoma following UAE and of timely source control to prevent severe complications.