Journal of Yeungnam Medical Science

영남대 의대 학술지 편집위원회 (Yeungnam University College of Medicine, Yeungnam University Institute Medical Science)
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A successful management after preterm delivery in a patient with severe sepsis during third-trimester pregnancy

  • Ra, Moni (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Kim, Myungkyu (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Kim, Mincheol (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Shim, Sangwoo (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Hong, Seong Yeon (Department of Obstetrics and Gynecology, Catholic University of Daegu School of Medicine)
  • 투고 : 2016.08.06
  • 심사 : 2016.10.31
  • 발행 : 2018.06.30
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초록

A 33-year-old woman visited the emergency department presenting with fever and dyspnea. She was pregnant with gestational age of 31 weeks and 6 days. She had dysuria for 7 days, and fever and dyspnea for 1 day. The vital signs were as follows: blood pressure 110/70 mmHg, heart rate 118 beats/minute, respiratory rate 28/minute, body temperature $38.7^{\circ}C$, and oxygen saturation by pulse oximetry 84% during inhalation of 5 liters of oxygen by nasal prongs. Crackles were heard over both lung fields. There were no signs of uterine contractions. Chest X-ray and chest computed tomography scan showed multiple consolidations and air bronchograms in both lungs. According to urinalysis, there was pyuria and microscopic hematuria. She was diagnosed with community-acquired pneumonia and urinary tract infection (UTI) that progressed to severe sepsis and acute respiratory failure. We found extended-spectrum beta-lactamase producing Escherichia coli in the blood culture and methicillin-resistant Staphylococcus aureus in the sputum culture. The patient was transferred to the intensive care unit with administration of antibiotics and supplementation of high-flow oxygen. On hospital day 2, hypoxemia was aggravated. She underwent endotracheal intubation and mechanical ventilation. After 3 hours, fetal distress was suspected. Under 100% fraction of inspired oxygen, her oxygen partial pressure was 87 mmHg in the arterial blood. She developed acute kidney injury and thrombocytopenia. We diagnosed her with multi-organ failure due to severe sepsis. After an emergent cesarean section, pneumonia, UTI, and other organ failures gradually recovered. The patient and baby were discharged soon thereafter.

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