Endomyometritis caused by HSV-2 in an immunocompromised woman

Summary A 64-year-old woman with progressive CLL presented with fever and lower abdominal discomfort 29 days after an uneventful LLETZ. Clinical examination revealed massive necrosis of the cervix and proximal vagina. Open abdominal hysterectomy, bilateral salpingo-oophorectomy, partial colpectomy, and partial deperitonealisation of the lesser pelvis was performed. In the surgical specimens, PCR analysis showed high amounts of herpes simplex virus type 2 (HSV-2).

Case A 64-year-old patient with CLL under therapy with acalabrutinib presented in our ER with fever, lower abdominal pain, and vaginal discharge 29 days after a LLETZ due to CIN III. Clinical examination showed a necrotizing inflammation in the LLETZ crater and the proximal vaginal walls. The laboratory results displayed an anemia (hemoglobin 4.7 mmol/l), leukocytopenia (1.9 G/l), elevated CRP levels (203 mg/l), and a PCT at 0.11 µg/ml.

We performed open surgery including an abdominal hysterectomy with bilateral salpingo-oophorectomy, partial colpectomy and partial pelvic deperitonealisation.

Histopathological analyses of the hysterectomy specimen presented nearly complete necroses of the uterus with abundant leiomyolysis and florid vasculitis but without any thrombotic change. An increase of the necrotic tissue was seen reaching from the uterine cervix up to the uterine corpus.

In surgical specimens, blood, urine, and bone marrow samples high amounts of HSV-2 DNA were shown. Initial antimicrobial treatment with piperacillin/tazobactam was escalated to imipenem plus vancomycin and supplemented by aciclovir therapy and immunoglobulin substitutions. The postoperative recovery was affected by progressive kidney failure, an acute exacerbation of COPD, and opportunistic infections with other pathogens.

Publikationsverlauf

Artikel online veröffentlicht:
11. Oktober 2022