Fatal postpartum infection.
Infectious Diseases in Clinical Practice
A 29-year-old G1P1001 female was discharged 2 days after an uncomplicated vaginal delivery requiring left mediolateral episiotomy. She presented to the emergency department 6 days later owing to progressively worsening labial swelling and pain, urinary retention, weakness, syncope, and intermittent fever and chills. Upon admission, her white blood cell (WBC) count was 25,500 bil/L with neutrophilia (18.7 bil/L); her hemoglobin (15.5 g/dL), hematocrit (44.8%), and platelet count (330 bil/L) were all normal. A computed tomography scan revealed mild pericardial and pleural effusions, moderate ascites, and bladder distension. After catheter placement, urinalysis showed 3+ blood, 2+ protein, 1+ leukocyte esterase, 1+ bacteria, and positive nitrites. Blood and urine cultures were obtained. She was empirically started on ampicillin, gentamicin, and clindamycin and then switched to vancomycin and piperacillin/ tazobactam after an infectious diseases consultation. Over the next 24 hours, she developed a marked leukemoid reaction (WBC count, 101.8 bil/L [neutrophils, 71.8 bil/L; metamyelocytes, 3.05 bil/L; myelocytes, 8.65 bil/L; promyelocytes, 3.56 bil/L]), hypotension, and mottling of her trunk and lower extremities. Emergent exploratory laparotomy revealed extensive tissue necrosis, requiring a total abdominal hysterectomy with bilateral salpingo-oophorectory. Ascites cultures were obtained. Histopathologic evaluation of the total abdominal hysterectomy with bilateral salpingo-oophorectory tissues revealed extensive acute suppurative inflammation and gangrenous necrosis of the endometrium and cervix. Gram-positive cocci, small gram-negative bacilli, and large gram-positive bacilli were readily observed.
Boyanton, Bobby L. Jr MD∗,†,‡; Hanna, Michel M. MD§; Hafez-Khayyata, Said MD‡,∥; Robinson-Dunn, Barbara PhD∗‡ Fatal Postpartum Infection, Infectious Diseases in Clinical Practice: January 2020 - Volume 28 - Issue 1 - p 53-54 doi: 10.1097/IPC.0000000000000797