SHM Converge Scientific Abstract ePoster Gallery-Opening the Vault: Uncovering a Rare Source of Sepsis

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This case report describes a rare source of sepsis in a 73-year-old bedbound nursing home resident with ESRD on hemodialysis, hypertension, and diabetes. She presented with malaise, chills, cough, and body aches. Initial evaluation showed leukocytosis but no clear infection source: she was afebrile, normotensive, chest X-ray was unrevealing, urinalysis was negative, and blood cultures remained negative.<br /><br />She was started on empiric vancomycin and aztreonam, but over the next few days developed worsening confusion, lethargy, fevers, hypotension, and increasing leukocytosis. Because the source remained unclear, her hemodialysis catheter was removed, but cultures were still negative. CT abdomen/pelvis then revealed a hyperdense pelvic collection with gas and debris, prompting OB/GYN consultation. Transvaginal ultrasound was not tolerated, so antibiotics were adjusted to ceftriaxone, metronidazole, and doxycycline. MRI later showed progressive hydrometra with persistent gas, consistent with pyometra.<br /><br />On hospital day 11, suction D&C was performed. Frank stool was found in the vaginal vault, and 300 cc of pus was drained from the uterus. The patient rapidly improved afterward.<br /><br />Pyometra is defined as pus within the uterus. It is rare, but more common in postmenopausal women and those with pelvic malignancy or prior radiation. Symptoms may include malodorous discharge, pelvic pain, bleeding, or no symptoms at all. In this patient, pyometra likely resulted from ascending bacterial spread related to fecal contamination, with her complete dependence for activities of daily living increasing vulnerability.<br /><br />The key teaching point is that pyometra can be an uncommon but important cause of sepsis in hospitalized nursing home patients. Because infection may be confined to the uterus, antibiotics alone may be insufficient; definitive source control with dilation and curettage is essential for recovery.

Asset Subtitle

Jessica Cristallo

Meta Tag

Author List Caitlin Sarubbi, Jessica Cristallo

Category Clinical Vignettes

Concept Pyometra

Concept Sepsis

Concept Source Control

Concept Diagnostic Workup

Concept Dilation and curettage

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center/ Albert Einstein College of Medicine

Presenting Author Jessica Cristallo

Track Adult

Keywords

pyometra

sepsis

nursing home resident

hemodialysis

end-stage renal disease

uterine infection

source control

dilation and curettage

pelvic collection

postmenopausal woman

Pyometra

Sepsis

Source Control

Diagnostic Workup

Dilation and curettage