Case report: An unusual presentation of puerperal sepsis

Abstract

Group A Streptococcus (GAS; Streptococcus pyogenes) is a facultative gram-positive coccus, uncommonly colonizing parturient genitalia, where its presence can potentially lead to a life-threatening invasive infection after delivery. GAS infection typically occurs within the first 4 days post-partum and is characterized by high fever, chills, flashing, abdominal pain, and uterine tenderness. Nonetheless, patients with GAS puerperal sepsis may have an unusual presentation, when fever is absent, and the symptoms and signs can be mild, non-specific, and not indicative of the severity of infection. This unusual presentation may lead to a delayed diagnosis and increase the risk for severe puerperal sepsis. Therefore, in these cases, a high index of suspicion and prompt early antibiotic and surgical treatment is crucial to saving the parturient's life.

Keywords: Group A Streptococcus; infection in pregnancy; maternal mortality; maternal sepsis; puerperal sepsis.

FIGURE 1

Macroscopic examination of the uterus: Hypertrophic post-partum uterus with necrotic tissue (white arrows), following severe Streptococcus pyogenes puerperal sepsis.

FIGURE 2

Histological specimens of the uterus. Microscopic examination of the uterus showing: (A) Hypertrophic post-partum uterus with acute inflammatory process characterized by extensive areas of recent hemorrhage and dilated congested vessels of the placental site. Black arrows indicate the focus of necrotic myometrium with bacterial colonies (hematoxylin and eosin staining, X1.25); (B) Acute inflammation with necrotic myometrium. Black arrows indicate bacterial colonies (hematoxylin and eosin staining, X60).