Pyomyoma is a rare, yet potentially fatal complication of uterine leiomyoma. Clinically difficult to diagnose as a result of non-specific symptoms, its presentation is commonly confused with fibroid degeneration. Late diagnosis has severe implications, with the mortality of the condition remaining high. Despite the availability of powerful antibiotics, surgical intervention is frequently required for the curative treatment of the critically ill patient. Here, we report a case of postpartum pyomyoma developing after a complicated antenatal course of placenta praevia resulting in recurrent antepartum haemorrhage, preterm prelabour rupture of membranes and eventual emergency caesarean section for cord prolapse. We highlight the diagnostic difficulty and delay in definitive surgical intervention. Using this case, we have emphasised the importance of strong clinical suspicion when faced with a triad of pain, sepsis without an obvious source and a known diagnosis of leiomyoma to prevent fatalities.

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Myomatous erythrocytosis syndrome is polycythaemia associated with uterine leiomyoma, a rare condition known for over five decades with unclear aetiology. The present case is a 51-year-old Caucasian woman who presented with urinary retention and anaemia secondary to multiple uterine fibroids and menorrhagia 5 years following uterine artery embolisation. She opted for abdominal hysterectomy but preoperatively was found to be polycythaemic with haemoglobin of 23 g% and raised serum erythropoietin requiring serial venesections. At a year postoperatively she maintains normal haemoglobin and serum erythropoietin levels. Ectopic production of erythropoietin by fibroids is the most favoured aetiopathogenesis in this case. However, the rapid transition from anaemia to polycythaemia in 5 months is a striking feature as fibroid-linked polycythaemia has so far been reported on presentation. Vigilance is crucial in excluding polycythaemia while such patients are on waiting list as there is a risk of thromboembolism, which is further increased by surgery.