Sepsis Due to Co-Infection with Human Papillomavirus and Acinetobacter Schindleri after Surgery for Uterine Fibroids

Case

A 33-year-old woman underwent a physical examination at the Department of Gynecology and was found to have uterine fibroids. She was admitted for laparoscopic removal of the uterine fibroids under general anesthesia. During the operation, there was a small amount of dark red ascites in the pelvic cavity, a part of the intestine was densely adhered to the right pelvic wall, and the uterus was enlarged to the size of 10 weeks gestation, with an uneven surface. There was a fibroid tumor measuring approximately 7 × 8 × 8 cm on the posterior wall of the uterus, which was hard with clear boundaries. Two vesicular clear-fluid cysts with a diameter of 1-1.5 cm were seen on each fallopian tube. Due to the large posterior wall myoma and difficulty in suturing, the patient was considered barren; hence, abdominal myomectomy and pelvic adhesiolysis were selected, followed by indwelling catheterization. On the first day after surgery, the patient felt cold and was shivering, with a temperature of 38.5°C and lower abdominal pain. There was no sign of infection in the abdominal incision. When the indwelling catheter was removed, there was no urethral inflammation observed and the patient was able to urinate without difficulty. Blood was immediately drawn for culture and biochemical tests, which revealed low levels of sodium, calcium, and magnesium, and abnormal coagulation function. The level of original calcitonin was normal. The blood culture was positive after 15.3 hours in a nutrient solution for gram-negative bacilli. A diagnosis of sepsis was made based on the clinical features and laboratory values. Gram staining revealed short Gram-negative bacilli (Figure 1A). The blood culture plate showed gray and white colonies with good growth (Figure 1B). The chocolate culture plate showed poor growth (Figure 1C), while the MacConkey plate did not show any organism growth. (Figure 1D).

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