Garnerella vaginalis bacteremia after vaginal myomectomy

Abstract

A 49-year-old woman was referred for evaluation of chronic pelvic pain and genital bleeding. Past medical history was otherwise unremarkable and she had one previous vaginal delivery. Pelvic examination revealed a posterior fibroma. Pelvic sonography confirmed a single interstitial posterior fibroma (65 mm 56 mm 45 mm) and a left anechogenous collection (91 mm 74 mm). At diagnostic laparoscopy adhesiolysis between left tubal and sigmoid was performed and a liquid collection evacuated. The ovaries were normal, but access to the posterior fibroma was limited by synechia between fibroma and rectum. At the end of laparoscopy, vaginal myomectomy was performed. No complication occurred during intervention. Prophylactic antibiotics were given during intervention (cefoxitrin 1 g IV). On postoperative day 3, patient had hyperthermia with pelvic pain. Two blood cultures were positives with Garnerella sp. and one blood culture was positive with Peptostreptococcus sp. Antibiotics including metronidazole were administered. On postoperative day 6, vaginal examination revealed an abscess of the vaginal cuff confirmed by pelvic sonography. Vaginal surgical evaluation was performed. Postoperative evolution as normal and patient discharged on postoperative day 11. 2. Discussion