Multiple necrotic uterine leiomyomas causing severe puerperal fever: ultrasound, CT, MR, and histological findings

The case of a patient with severe fever in the puerperium is presented. Ultrasound, CT, and MRI revealed multiple myomas; all the myomas, even the smallest ones, were hypodense on pre- and postcontrast enhanced CT and presented with high signal intensities on T2-weighted MRI. After hysterectomy, histology demonstrated necrosis of all leiomyomas without hemorrhage or inflammatory reaction. Therefore, fever was caused solely by extensive necrotic degeneration of the fibroids, probably due to hypoperfusion related to delivery or hormonal changes during pregnancy and puerperium.