BACKGROUND:

Infectious complications due to diagnostic hysteroscopy are uncommon, being only 0.6% of all complications.

CLINICAL CASE:

A 46-year-old patient who, 6 days after performing an outpatient diagnostic hysteroscopy due to endometrial polyps, was admitted to the Gynecology Department, due to pyomyositis of the left piriformis muscle secondary to Streptococcus pyogenes bacteremia after gynecological procedure. Antithrombotic treatment was initiated with Enoxaparin 40 mg, 1/24h subcutaneously and antibiotic therapy with Ceftriaxone 2g/24h intravenously (iv) and Gentamicin 240 mg/24h iv, which 48 hours later were changed to Amoxicillin 1g/8h orally (VO) and Clindamycin 300 mg/8 hours orally for another 7 days. In the 10-day control magnetic resonance imaging (MRI), septic thrombophlebitis was seen in the left internal iliac vein as well as persistence of the pyomyositis condition, with intra and extramuscular pelvic collections. Therefore, a new admission was decided to start antibiotic therapy again with Amoxicillin 1g/8h IV and Clindamycin 900 mg/8h IV, which was suspended 24 hours after assessment by the Infectious Diseases Unit; and new antithrombotic treatment with Fraxiparin Forte 0.5 mL/24h subcutaneous, by consensus with the Vascular Surgery Service. ECO-DOPPLER was performed, which ruled out Deep Venous Thrombosis (DVT); and negative blood cultures. The patient was discharged with Fraxiparina Forte 0.5 mL/24h for 6 weeks presenting good clinical evolution. A new MRI control was scheduled for the following month, finding a complete resolution of the inflammatory process. Currently, one year later, the patient is asymptomatic and continues in annual follow-up in our consultations.

CONCLUSIONS:

Outpatient diagnostic hysteroscopy is an effective and safe technique. Infectious complications derived from the technique are infrequent, which is why it is not necessary to perform an antibiotic prophylaxis in patients who are going to undergo this test

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