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Acute fungal endometritis in women with abnormal uterine bleeding: Clinical and microbiological insights

Summary

Women with persistent abnormal uterine bleeding often undergo extensive testing without finding a cause. This study discovered that fungal infections, caused by Candida species, may be responsible for about 12% of such cases. The researchers found that direct sampling of the uterine lining is essential for diagnosis since surface vaginal cultures miss these infections. Treatment with an antifungal medication called voriconazole combined with surgical cleaning of the uterus proved effective in resolving the condition.

Background

Fungal endometritis is a rare but severe inflammatory infection of the uterine lining that typically presents with abnormal uterine bleeding (AUB), pelvic discomfort, and vaginal discharge. While bacterial infections are the most common cause of endometritis, fungal etiologies remain under-recognized due to diagnostic challenges and symptom overlap with other uterine pathologies.

Objective

This study aimed to provide a comprehensive clinical and microbiological characterization of acute fungal endometritis in women presenting with abnormal uterine bleeding, with emphasis on accurate diagnosis and fungal species identification.

Results

Five patients (11.62%) were definitively diagnosed with fungal endometritis, including two isolates of Candida albicans, two of Nakaseomyces glabratus, and one of Candida orthopsilosis. Notably, all confirmed cases exhibited negative vaginal discharge cultures, emphasizing the necessity of direct endometrial sampling. All isolates were susceptible to voriconazole treatment combined with surgical debridement.

Conclusion

This study highlights the critical importance of prompt and precise diagnosis including fungal species identification and comprehensive antifungal susceptibility testing in cases of acute endometritis with AUB. Voriconazole treatment combined with surgical debridement proved effective, though larger multi-center studies are needed to establish optimal diagnostic and therapeutic guidelines.
  • Published in:Current Medical Mycology,
  • Study Type:Clinical Case Series,
  • Source: PMID: 41122112, DOI: 10.22034/cmm.2025.345248.1650
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