pywin32, up until recently, just listed 3 directories in its .pth file - these were for directories which pre-dated packages and were never converted. Eg, "import win32api" actually loads win32api.pyd from the "site-packages/win32" directory.

Earlier this year, via https://github.com/mhammond/pywin32/issues/1151, I also added the line:

import os;os.environ["PATH"]+=(';'+os.path.join(sitedir,"pywin32_system32"))

which is to support pywin32 being installed from wheels - this is due to pywin32 shipping with various shared DLLs which implement many pywin32 types - eg, pywintypesXX.dll is used by (almost) every single .pyd shipped with pywin32, and disutils doesn't offer any way of copying files as part of a post-install script or any other way of ensuring these .dll files are on the PATH or otherwise next to pythonXX.dll/.exe

I'm happy to replace both of these with alternatives when they exist.