Pyometrocolpos: A Case Series and Proposed Management Framework for the Pediatric Infectious Diseases Consultant.

BACKGROUND: Congenital anomalies of the female reproductive tract commonly present during adolescence with abdominal pain secondary to hematometrocolpos. At the time of diagnosis, many patients will have signs and symptoms concerning for infection of retained blood products, termed pyometrocolpos. Cases of pyometrocolpos have rarely been described, posing challenges for the pediatric infectious diseases consultant in determining the risk of true infection and appropriate antimicrobial therapy.

CASE SUMMARIES: This case series first describes a 12-year-old female with a history of left renal agenesis who presented with a new diagnosis of obstructed hemivagina and ipsilateral renal anomaly syndrome. Concern was raised for infection of retained blood products due to fever and elevated C-reactive protein; however, drainage proved negative for true infection. The second case describes a patient with complex urogenital anatomy and an indwelling drain for management of hematometrocolpos who presented with fever and purulent uterine drainage. While skin and soft tissue pathogens were initially suspected, cultures grew Parvimonas micra and Gemella morbillorum . The patient recovered well with surgical washout and a short course of ampicillin-sulbactam therapy.

CONCLUSIONS: While children with female reproductive tract anomalies may present with concern for pyometrocolpos, it is important to differentiate between inflammatory symptoms from retained blood products and those caused by bacterial infection. We present a framework for approaching management of suspected pyometrocolpos and discuss the microbiologic differential for proven cases.