ABSTRACT
Upper genital tract infection by Cryptococcus neoformans has not previously been reported. We describe such a case, in order to alert clinicians to the existence of this rare infection. A 34-year-old woman with AIDS presented with chronic menorrhagia, fever, anemia, and thrombocytopenia. Despite blood transfusions and hormonal therapy, her vaginal bleeding could not be controlled and she became hemodynamically unstable. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed, at which time granulomatous peritonitis and prominent myometrial blood vessels were found. Histologic examination revealed cryptococcal infection of all upper genital organs. This case demonstrates that disseminated cryptococcosis may involve the upper genital tract in women, and may be associated with profuse vaginal bleeding.
Subject(s)
AIDS-Related Opportunistic Infections , Cryptococcosis , Cryptococcus neoformans/pathogenicity , Fallopian Tubes , Genital Diseases, Female , Ovary , Uterus , AIDS-Related Opportunistic Infections/microbiology , AIDS-Related Opportunistic Infections/pathology , AIDS-Related Opportunistic Infections/surgery , Adult , Cryptococcosis/microbiology , Cryptococcosis/pathology , Cryptococcosis/surgery , Cryptococcus neoformans/isolation & purification , Fallopian Tubes/microbiology , Fallopian Tubes/pathology , Female , Genital Diseases, Female/microbiology , Genital Diseases, Female/pathology , Genital Diseases, Female/surgery , Genitalia, Female/microbiology , Genitalia, Female/pathology , Humans , Hysterectomy , Ovariectomy , Ovary/microbiology , Ovary/pathology , Uterus/microbiology , Uterus/pathologyABSTRACT
BACKGROUND: Microwave endometrial ablation is an effective treatment for dysfunctional uterine bleeding. Patients with leiomyomata, including submucosal leiomyomata up to 3 cm, may also be treated with microwave endometrial ablation. CASES: A 46-year-old woman with multiple leiomyomata and menometrorrhagia underwent microwave endometrial ablation. Two months after microwave endometrial ablation, she developed signs of peritoneal irritation. A negative laparoscopy excluded a thermal bowel injury. Imaging and clinical examination ultimately determined that her symptoms were due to leiomyoma degeneration. A 38-year-old woman with menometrorrhagia and leiomyomata underwent microwave endometrial ablation. Fifteen days after microwave endometrial ablation, she developed signs of peritoneal irritation. With a presumptive clinical diagnosis of microwave endometrial ablation degeneration, the patient was expectantly managed with pain medications and observation. CONCLUSION: Fibroid degeneration may have a delayed presentation after microwave endometrial ablation. Thermal bowel injury must be excluded in a patient presenting with signs of peritoneal irritation after microwave ablation of the endometrium before diagnosing leiomyoma degeneration, which can be managed expectantly.
