Upper genital tract infection by Cryptococcus neoformans has not previously been reported. We describe such a case, in order to alert clinicians to the existence of this rare infection. A 34-year-old woman with AIDS presented with chronic menorrhagia, fever, anemia, and thrombocytopenia. Despite blood transfusions and hormonal therapy, her vaginal bleeding could not be controlled and she became hemodynamically unstable. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed, at which time granulomatous peritonitis and prominent myometrial blood vessels were found. Histologic examination revealed cryptococcal infection of all upper genital organs. This case demonstrates that disseminated cryptococcosis may involve the upper genital tract in women, and may be associated with profuse vaginal bleeding.

McCrosson, Stacy A. MD; Airoldi, James MD; Nogami, Suzanne; Berghella, Vincenzo MD Author Information

Airoldi, James A. MD; Ness, Amen MD; McCrosson, Stacy MD; Carpenter, Pamela; Pereira, Leonardo MD; Berghella, Vincenzo MD Author Information

Airoldi, James A. MD; McCrosson, Stacy MD; Ness, Amen MD; Sarno, Albert MD; Berghella, Vincenzo MD Author Information

ObjectiveTo evaluate which risk factors are significantly associated with worsening maternal disease, focusing on chronic and active hepatitis C.Study designA retrospective review was completed for hepatitis C pregnant women from 2000-2003. Chronic hepatitis C is defined as hepatitis C viral RNA in the serum, while chronic active hepatitis C is defined as hepatitis C viral RNA plus abnormal liver function tests (LFT's).ResultsOf 76 pregnant women with known hepatitis c viral titers, 63 women had positive viral titers (chronic infection rate 83%). Within the chronic infection group with known LFT's, 33 had abnormal LFT's (52%). Smoking and previous drug use were significantly associated with chronic hepatits C. (Table)ConclusionTabled 1Non-viremic hep CChron hep C (viremic)p valueChron non-active hep CChron active hep Cp valueN13632933Age (mean)28.029.60.4929.029.90.48Duration (years)4.12.60.413.12.20.30HIV viral load1813.33156.80.603510.72941.50.88Methadone dose (mg)113.795.10.6091.398.60.55HIV pos2 (15%)8 (13%)0.792 (7%)6 (18%)0.18Hep B pos5 (38%)12 (19%)0.127 (24%)5 (15%)0.37Smoke10 (77%)60 (95%)0.0229 (100%)30 (91%)0.09Prev drug use8 (62%)63 (100%)0.0029 (100%)33 (100%)— Open table in a new tab ObjectiveTo evaluate which risk factors are significantly associated with worsening maternal disease, focusing on chronic and active hepatitis C. To evaluate which risk factors are significantly associated with worsening maternal disease, focusing on chronic and active hepatitis C. Study designA retrospective review was completed for hepatitis C pregnant women from 2000-2003. Chronic hepatitis C is defined as hepatitis C viral RNA in the serum, while chronic active hepatitis C is defined as hepatitis C viral RNA plus abnormal liver function tests (LFT's). A retrospective review was completed for hepatitis C pregnant women from 2000-2003. Chronic hepatitis C is defined as hepatitis C viral RNA in the serum, while chronic active hepatitis C is defined as hepatitis C viral RNA plus abnormal liver function tests (LFT's). ResultsOf 76 pregnant women with known hepatitis c viral titers, 63 women had positive viral titers (chronic infection rate 83%). Within the chronic infection group with known LFT's, 33 had abnormal LFT's (52%). Smoking and previous drug use were significantly associated with chronic hepatits C. (Table) Of 76 pregnant women with known hepatitis c viral titers, 63 women had positive viral titers (chronic infection rate 83%). Within the chronic infection group with known LFT's, 33 had abnormal LFT's (52%). Smoking and previous drug use were significantly associated with chronic hepatits C. (Table) ConclusionTabled 1Non-viremic hep CChron hep C (viremic)p valueChron non-active hep CChron active hep Cp valueN13632933Age (mean)28.029.60.4929.029.90.48Duration (years)4.12.60.413.12.20.30HIV viral load1813.33156.80.603510.72941.50.88Methadone dose (mg)113.795.10.6091.398.60.55HIV pos2 (15%)8 (13%)0.792 (7%)6 (18%)0.18Hep B pos5 (38%)12 (19%)0.127 (24%)5 (15%)0.37Smoke10 (77%)60 (95%)0.0229 (100%)30 (91%)0.09Prev drug use8 (62%)63 (100%)0.0029 (100%)33 (100%)— Open table in a new tab

BACKGROUND: Microwave endometrial ablation is an effective treatment for dysfunctional uterine bleeding. Patients with leiomyomata, including submucosal leiomyomata up to 3 cm, may also be treated with microwave endometrial ablation.CASES: A 46-year-old woman with multiple leiomyomata and menometrorrhagia underwent microwave endometrial ablation. Two months after microwave endometrial ablation, she developed signs of peritoneal irritation. A negative laparoscopy excluded a thermal bowel injury. Imaging and clinical examination ultimately determined that her symptoms were due to leiomyoma degeneration. A 38-year-old woman with menometrorrhagia and leiomyomata underwent microwave endometrial ablation. Fifteen days after microwave endometrial ablation, she developed signs of peritoneal irritation. With a presumptive clinical diagnosis of microwave endometria ablation degeneration, the patient was expectantly manage with pain medications and observation.CONCLUSION: Fibroid degeneration may have a delayed presentation after microwave endometrial ablation. Thermal bowel injury must be excluded in a patient presenting with signs of peritoneal irritation after microwave ablation of the endometrium before diagnosing leiomyoma degeneration, which can be managed expectantly.