Postpartum fever is a common problem for obstetricians, but fever of unknown origin (FUO) occurring in the puerperium may be relatively unfamiliar and a challenge to the majority of obstetricians.A 29-year-old woman had a FUO detected during the puerperium. Despite serial examinations and therapeutic trials, the fever persisted for three weeks without a clinical improvement or definite infection source. The presence of a huge uterine myoma was observed. The patient finally underwent myomectomy, and a pathology review revealed a cellular leiomyoma associated with massive infarction and acute inflammation. The fever subsided substantially on the third day postoperatively.Although a uterine leiomyoma as a cause of fever in the puerperium is not new, rarely does it cause prolonged fever. It should be taken into consideration in pregnant women known to have uterine myomas during pregnancy and in the puerperium, especially if FUO develops. Nonsteroidal antiinflammatory drugs can be a tool for making the differential diagnosis in such a patient, and exploratory laparotomy can be delayed until an emergency condition occurred, especially important during pregnancy.
Mature teratoma (dermoid cyst) is a common disorder in women of reproductive age. Sometimes the tumor is complicated by torsion, rupture, and malignant change. However, it rarely presents with fever. We present a 38-year-old woman with an intermittent fever for 30 days, who received occasional medical treatment without improvement. She was to our clinic for evaluation and treatment; however, fever persisted for three days without clinical improvement. No definite infection source could be identified except the presence of a huge pelvic tumor. The patient underwent exploratory laparotomy and an ovarian dermoid cyst with infection was noted. Pathology review revealed mature teratoma with superimposed infection by Escherichia coli. Fever impressively subsided on the fifth postoperative day. Although the majority of patients suffering from fever initially search for medical treatment at primary clinics, rare conditions such as persistent fever should be consulted by specialists to make differential diagnosis. Mature teratoma is rarely superimposed by infection and rarely causes fever. Furthermore, the possibility of fever caused by tubo-ovarian abscess (TOA) is often missed in patients with history of tubal ligation since there is a lower incidence of TOA in these unique patients. However, based on this case report, we should be alert whenever long-term fever is noted. Prompt surgical treatment for extirpation and an appropriate antibiotic treatment would be the choice of treatment in such cases.
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