Hadjilouca Christina, Efseviou Christos, Kastoris Antonia, Vavlitou Anna
Intensive Care Unit, Nicosia General Hospital, Nicosia, CYP.
Cureus. 2025 Apr 14;17(4):e82278. doi: 10.7759/cureus.82278. eCollection 2025 Apr.
Fever following decannulation from extracorporeal membrane oxygenation (ECMO) poses diagnostic challenges. While infectious causes and thrombosis are typically considered, rare etiologies may be overlooked. We report the case of a 47-year-old woman who developed a high, refractory fever following veno-arterial (va) extracorporeal membrane oxygenation decannulation. Extensive infectious and non-infectious workups failed to identify a definitive cause as cultures, imaging modalities, and inflammatory markers were inconclusive. On post-ECMO day 9 and 23 days after initial admission to the hospital, a gynecological examination was prompted by unexplained unilateral labial edema and prolonged menstruation. Speculum examination revealed a retained menstrual cup embedded in the cervix, causing local inflammation. Following its removal, the patient's fever rapidly resolved, without the need for further antibiotic escalation. Menstrual cups are generally considered safe, with rare complications such as toxic shock syndrome, pelvic infections, and mechanical injuries. However, in critically ill patients unable to provide a complete history, retained menstrual cups can lead to significant inflammatory responses and diagnostic delays. This case highlights the importance of maintaining a broad differential diagnosis, including gynecological evaluation, in cases of unexplained fever, particularly in critically ill patients.
体外膜肺氧合（ECMO）撤机后发热带来了诊断挑战。虽然通常会考虑感染性病因和血栓形成，但罕见病因可能会被忽视。我们报告了一例47岁女性，她在静脉-动脉（va）体外膜肺氧合撤机后出现了高热且难治性发热。广泛的感染性和非感染性检查未能确定明确病因，因为培养结果、影像学检查和炎症标志物均无定论。在ECMO撤机后第9天以及入院后23天，因不明原因的单侧阴唇水肿和月经延长而进行了妇科检查。窥器检查发现一个月经杯嵌顿在宫颈内，引起局部炎症。取出月经杯后，患者的发热迅速消退，无需进一步升级抗生素治疗。月经杯通常被认为是安全的，罕见并发症如中毒性休克综合征、盆腔感染和机械性损伤。然而，在无法提供完整病史的重症患者中，月经杯嵌顿可导致显著的炎症反应和诊断延迟。该病例强调了在不明原因发热病例中，尤其是重症患者，保持广泛鉴别诊断的重要性，包括妇科评估。
