Pyometra is an uncommon but serious condition that is generally diagnosed in post-menopausal women. It rarely occurs in premenopausal patients, particularly adolescents.
A 16yo with multiple comorbidities including severe intellectual disability, neurogenic bladder, and recurrent UTIs presented with fevers, abdominal pain, and vaginal discharge after prolonged treatment with depot medroxyprogesterone acetate (DMPA). Ultrasound demonstrated an intrauterine fluid collection consistent with hematometra; however, hysteroscopic evaluation confirmed pyometra, which was evacuated using a suction curette. Despite post-operative antibiotic therapy, she re-presented with similar findings requiring additional hysteroscopic evaluation and evacuation. Following a third evacuation, an intrauterine catheter was placed to aid in drainage. This was not tolerated by the patient, and she ultimately required total laparoscopic hysterectomy for definitive management, which was performed without incident.
Pyometra is a rare occurrence that typically presents after menopause; however, it should be considered in patients with poor genitourinary hygiene and medically induced endometrial atrophy. In severe cases, hysterectomy may be required for definitive management.

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