Post C-section complicated by M. Hominis Abscess | ACP MI Residents Day 2021

Pelvic abscesses after endometritis occurs in less than 1% of postpartum women, with the most common areas being the broad ligament, posterior cul-de-sac, and anterior to the uterine wall. Our case is even more uncommon as multiple Mycoplasma Hominis abscesses developed after Cesarean section and were not all contained in the pelvis.

A 24-year-old woman who delivered via C-Section eight days prior to admission presented with abdominal pain and signs of pulmonary embolism confirmed on CT-angiography. Of note, she had been treated for chorioamnionitis. The development of leukocytosis and fever, with recent abdominal surgery prompted imaging. CT Abdomen/Pelvis showed a multilocular fluid collection anterior to the uterus, and abdominopelvic ascites. Piperacillin-Tazobactam and Linezolid were initiated but she did not clinically improve; repeat imaging showed a posterior cul-de-sac fluid collection developing into an abscess. The patient underwent drainage of both anterior and posterior collections after which, initially, leukocytosis improved and the patient defervesced. However, due to relapsing fever and worsening leukocytosis, antibiotics were escalated to Meropenem. Anterior abscess cultures grew M. hominis, which had not been covered; the posterior fluid grew E. coli and E. faecalis. Moxifloxacin was added to c over M. hominis. Later on, repeat imaging showed new peri-aortic and peri-splenic abscesses, which, after drainage, resulted in significant clinical improvement. Only the peri-aortic abscess showed culture growth, which was M. hominis. She was prescribed a six-week course of piperacillin-tazobactam for E. coli and E. faecalis coverage, and moxifloxacin for M. hominis coverage, along with follow up and repeat imaging.

M. hominis infections after C-sections have been reported in a few cases. Due to its resistance to common antimicrobial drugs, it is important to bear Mycoplasma in mind in the lack of clinical improvement. This can prevent the potential spread and abscess formation in other organs.