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

Summary

This study examined a rare fungal infection of the uterus called fungal endometritis that causes abnormal bleeding and discomfort in women. Researchers found that about 12% of women with unexplained abnormal bleeding had this fungal infection, which was caused by different species of Candida yeast. A simple test using vaginal swabs was not effective for diagnosis; instead, doctors needed to take samples directly from the uterine lining. Treatment with an antifungal medication called voriconazole combined with surgical cleaning was successful in all cases studied.

Background

Fungal endometritis is a rare but severe inflammatory infection of the uterine lining that typically presents with abnormal uterine bleeding, pelvic discomfort, and vaginal discharge. While bacterial infections are the most common cause of endometritis, fungal etiologies represent a potentially serious manifestation. This study addresses a significant diagnostic gap by providing comprehensive characterization of acute fungal endometritis in symptomatic women.

Objective

This investigation aimed to present the first global study focused on fungal endometritis in women presenting with abnormal uterine bleeding and related clinical symptoms. The study sought to establish diagnostic protocols and clinical management strategies for this underrecognized condition.

Results

Five patients (11.62%) received a definitive diagnosis of fungal endometritis. Identified species included two isolates of Candida albicans, two isolates of Nakaseomyces glabratus, and one isolate of Candida orthopsilosis. All confirmed cases showed negative vaginal discharge cultures, emphasizing the necessity of direct endometrial sampling. All isolates responded effectively to voriconazole treatment combined with surgical debridement.

Conclusion

This study highlights the critical importance of prompt evaluation and precise diagnosis, including comprehensive antifungal susceptibility testing, for individuals with acute endometritis and abnormal uterine bleeding. The emergence of non-albicans Candida species as significant pathogens and increasing antifungal resistance necessitate routine species-level identification and targeted antifungal therapy for improved patient outcomes.
  • Published in:Current Medical Mycology,
  • Study Type:Clinical Case Series,
  • Source: PMID: 41122112, DOI: 10.22034/cmm.2025.345248.1650
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