Postoperative streptococcus constellatus bacteremia in a 75-year-old patient with pyometra: A case report

Background: Pyometra is an accumulation of pus in the uterine cavity. It is rare in the general population but more common in elderly women. If diagnosed in the early stage, life-threating conditions may be avoided. The most common etiological microorganisms of pyometra are Escherichia coli, Bacteroides species, Staphylococci (eg, epidermid-is) and Streptococci. Occasionally, atypical bacteria may be the cause. Case Report: We present the case of a 75-year-old woman, with multiple risk factors, admitted to the Gynecology Department with a 15-day history of yellowish-brown vaginal discharge. Because of rapid enlargement of the uterine cavi-ty, the patient underwent to endometrial curettage. Three hours after surgery, she developed a high-grade fe-ver, and Streptococcus constellatus was isolated in her blood cultures. A specific antibiotic therapy was admin-istered for a total of 14 days, resulting in complete resolution of the infection. Conclusions: This case report describes a rare case of bacteremia caused by Streptococcus constellatus, that resulted from a pyometra. The classic triad of symptoms (postmenopausal bleeding, vaginal discharge, and lower abdominal pain) may be helpful for diagnosis; however, 50% of patients are asymptomatic. An early recognition of the con-dition is important to avoid rare but risky consequences, such as perforation of the uterus itself. Nevertheless, surgery can cause dangerous complications such as bacteremia. A different spectrum of bacteria may be in-volved in the development of pyometra, even in atypical cases, mostly when multiple comorbidities are pres-ent. A correct evaluation and management of the patient is essential to guarantee a good prognosis in this rare infection.