RESISTANT PYOMETRA IN POST-MENOPAUSAL WOMAN WITH POORLY CONTROLLED DIABETES MELLITUS: A CASE REPORT.

WM Nazlee WZ, Rosnani Z, Imran A

Family Medicine Department, School of Medical Science, Health Campus,Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

ABSTRACT

Pyometra is a rare disease defined by accumulation of pus inside uterine cavity. Poorly controlled diabetes mellitus can predispose post-menopausal women to develop pyometra as diabetes is known to suppress patients’ immune system and impair the natural drainage of the uterus. We reported here the case of a 66-year-old post-menopausal woman with poorly controlled diabetes who came with a complaint of vaginal whitish brown discharge for one week. The diagnosis of pyometra was made on ultrasound scanning, which is challenging especially in primary care where ultrasound scan may not be widely available. Patient was managed with hysteroscopy endometrial curettage and antibiotics by the admitting gynecology team. Result of biopsy was reported as chronic inflammation but patient refused for further surgical intervention. She was managed conservatively and her diabetes was better controlled on insulin treatment with improvement of her vaginal discharge. This case highlights the important of thorough assessment in post-menopausal women presented with vaginal discharge especially if they have condition which suppressed their immune system. Early diagnosis of pyometra may prevent serious complication such as spontaneous uterine rupture and severe sepsis.

Keywords: Diabetes Mellitus;  Diabetes Complications; Post-menopausal; Pyometra; Vaginal discharge.

Correspondence: Rosnani Zakaria MAFP (Malaysia), FRACGP (Australia), Family Medicine Department,School of Medical Science, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.  Mobile no: +60199866763; Fax No: 09-7653370. email: rosnani@usm.my

Brunei Int Med J. 2019;15:53-57