Ciężka sepsa po poronieniu samoistnym ze współistniejącą glistnicą – opis przypadku

*Dorota Nosalska¹, Jerzy Paluszkiewicz¹, Irena Kijuk², Krzysztof Przesmycki³

Summary
Background.Sepsis complicating pregnancy may develop rapidly, mostly because of increased vascular permeability. Ascaris lumbricoides, the most prevalent human parasite, is usually asymptomatic but may be responsible for a variety of severe complications including sepsis and spontaneous abortion. We report a case of severe sepsis that occurred immediately after spontaneous abortion in a patient with coexisting ascariasis.
Case report. A 28-year-old woman (8/9^th gestational week of her second pregnancy) was admitted because of a spontaneous missed abortion and was discharged home after curettage. On the next day she returned because of high fever and respiratory distress, and was admitted to ITU in the early stages of septic shock with respiratory failure. Despite vigorous treatment (mechanical ventilation with FiO₂ 1.0 and PEEP 1 kPa, and inotropic support), she remained hypoxemic and hypotensive. An emergency hysterectomy was performed because of purulent necrotising myometritis, however she remained pyretic and hypoxemic. Recombinant human activated protein C infusion was introduced (24 mg kg^-1 h^-1 over 96 hours), resulting in gradual cardiovascular and respiratory improvement. The patient was extubated after four days. Bilirubin concentration was 83.4 ?m l^-1. On the third day of treatment, a large human ascaris was retrieved from the nasogastric tube, and albendazole was given. The woman made a satisfactory recovery and was discharged home after a 6-day stay in an infection ward.
Discussion and conclusion. The main cause of the severe sepsis that occurred in our patient was purulent myometritis, complicating spontaneous abortion. Coexisting parasitic infection may contribute to abortion and to subsequent septic complications. Early introduction of recombinant human activated protein C resulted in significant clinical improvement.

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