A febrile eruption after delivery

Excerpt

A 37-year-old Caucasian woman (parity 3) was admitted to the intensive care unit for hypotension, fever, sinusal tachycardia (150/min), abdominal pain, and an erythematous rash, 48 h after delivery. Chills, intense and unusual abdominal pain and vomiting have been noted 6 h after delivery. Examination revealed an erythematous evanescent non pruriginous abdominal (Fig. 1a) and palmar (Fig. 1b) rash. Explorative laparoscopy found purulent peritoneal effusion and a left pyosalpinx requiring annexectomy. All microbiological samples (blood cultures, vaginal swab, peritoneal fluid) as well as blood cultures obtained in her newborn were positive for Group A Streptococcus pyogenes. The patient received antibiotic therapy and intravenous polyvalent immunoglobulins and had a favorable outcome. Group A Streptococcus (GAS) is a common and severe cause of puerperal sepsis, which accounts for 15% of maternal mortality [1]. Pregnancy and post-partum period, even among women without underlying illness, are associated with a 20-fold increased incidence of GAS infection. What that should alert a clinician to streptococcal infection includes: a recent sore throat, extreme tachycardia, hyperalgesia, abdominal pain, evanescent rash, diarrhea and vomiting.

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