Pyometra is an unusual presentation of uterine infection, this condition is characterized by purulent fluid within the uterine cavity. In this report we describe pyometra due to Pseudomonas aeruginosa in a 90-year-old woman who presented with abdominal pain, nausea with emesis and diarrhea. She was evaluated at an outside emergency department and computed tomography (CT) revealed a large, complex, cystic mass measuring 9.2 cm (cm) in greatest diameter. Given her age, the diagnosis of malignancy was entertained. She was referred to gynecologic-oncology service for evaluation and underwent exploratory laparotomy with total abdominal hysterectomy and lysis of adhesions. Intraoperative findings were consistent with pyometra. Cultures ultimately grew Pseudomonas aeruginosa. She initiated on antibacterial therapy and was discharged to a rehabilitation facility.