A rare case of pyometra and secondary suspected septic shock caused by Facklamia hominis in a postmenopausal woman

Pyometra is a rare and potentially life-threatening uterine infection that predominantly affects postmenopausal women. Clinical recognition can be delayed due to non-specific symptoms, and atypical pathogens may further complicate diagnosis and management. Facklamia hominis is an uncommon, opportunistic Gram-positive coccus that colonises the human genital tract and is easily misidentified during routine microbial detection. To date, no cases of pyometra attributable to this organism have been reported. We present the first documented case of pyometra and secondary suspected septic shock caused by Facklamia hominis in an elderly postmenopausal woman, aiming to expand the clinical spectrum of this rare pathogen and alert clinicians to its potential severity. A 68-year-old postmenopausal woman with a medical history of chronic obstructive pulmonary disease (COPD) and coronary heart disease presented with chronic lower abdominal pain, malodorous vaginal discharge, and persistent fever. Pyometra was confirmed by pelvic imaging. The patient initially received empirical intravenous imipenem, followed by ultrasound-guided intrauterine pus drainage, which resulted in temporary symptomatic relief. Nevertheless, her clinical condition deteriorated abruptly one day after drainage, progressing to suspected septic shock. She subsequently underwent emergency total hysterectomy and bilateral salpingo-oophorectomy. Microbial culture of intrauterine pus identified the causative pathogen Facklamia hominis using matrix‑assisted laser desorption/ionisation time‑of‑flight mass spectrometry (MALDI‑TOF MS) combined with 16S rRNA gene sequencing. The patient achieved full recovery following empirical imipenem-based therapy and multidisciplinary supportive care. This case illustrates life-threatening pyometra from Facklamia hominis in a postmenopausal woman, where emergency hysterectomy was followed by recovery after failure of antibiotics and intrauterine drainage, reminding clinicians to watch for this easily-misidentified rare pathogen in vulnerable hosts.