Background: Suppurative leiomyoma (pyomyoma) is a rare complication of myoma. Pregnancy predisposes myoma for the acquisition of pyogenic infection. The expectant management of myoma is preferred during pregnancy, but pyomyoma mostly necessitates early surgical intervention to improve the maternal and fetal outcomes. A delayed diagnosis may result in lifethreatening complications. Case Presentation: We report a case of a 30-year-old female, second gravida presented to the emergency room at 33 weeks’ gestation with 10 days of abdominal pain, fever, and vomiting. Abdominal examination showed distended tensed uterus with fundal height corresponding to 36 weeks’ size Pyomyoma, which manifested as obstructive uropathy with acute kidney injury and managed successfully. The renal function test had a marked derangement with blood urea nitrogen being 76 mg/dl and serum creatinine of 2.6 mg/dl, with normal electrolytic values. Magnetic resonance imaging pelvis revealed an abdominopelvic mass of approximately 18 × 11 cm with peripheral T1 hyperintensity and diffusion restriction and bilateral hydroureteronephrosis with extension. Laparotomy showed an irregular ragged mass of approximately 16 × 10 cm extending from the posterior surface of the uterus to the right side broad ligament. It had friable degenerated tissues with purulent collection within it which was spontaneously draining suggestive of ruptured pyomyoma. Pyomyoma was enucleated, and the patient recovered well postoperatively. Conclusion: Pyomyoma should be strongly suspected in the cases of myoma with sepsis during pregnancy.

Keywords: Pyomyoma, sepsis, acute kidney injury, case report