Abstract
Abstract Introduction: sepsis is a serious public health problem, affecting millions of people in the world each year, with a high mortality rate (one out of four patients) and an increasing incidence. Sepsis is one of the main causes of maternal mortality and an important cause of admission to obstetric intensive care units. Case description: In this study, the authors report the case of a woman having been submitted to cesarean section three days before presenting clinical signs of sepsis and septic shock caused by a liver abscess. The patient had a set of complications secondary to shock, such as thrombocytopenia, coagulopathy, toe ischemia and acute kidney failure. The patient had cholelithiasis and recurrent pain in the right hypochondrium during pregnancy. During hospitalization, the mechanism involved in the development of hepatic abscess was infection of the biliary tract. The patient was treated in an obstetric intensive care unit with antibiotics and drainage of the liver abscess. Progress was favorable and the patient was discharged in good health. Discussion: pyogenic liver abscess during pregnancy and puerperium is a serious condition which represents a diagnostic and therapeutic challenge, with few cases reported. The normally nonspecific clinical and laboratory findings can lead to a late diagnosis, which increases the risk of maternal morbidity and mortality.
Highlights
Sepsis is a serious public health problem affecting millions of individuals throughout the world each year
On the fifth day after drainage of the liver abscess, with the resolution of sepsis and acute kidney failure, bed sores on the back and intergluteal region, toe ischemia and chronic arterial hypertension, the patient was in good clinical condition and was sent for rooming-in taking piperacillin/tazobactam (4.5 g every six hours), clonidine (0.3 mg/day), nifedipine (30 mg/day) and propranolol (80 mg/day)
The clinical condition of a woman in the puerperium deteriorated and the diagnosis of liver abscess was delayed, which led to significant morbidity
Summary
Sepsis is a serious public health problem affecting millions of individuals throughout the world each year. The mortality rate is high (one out of every four patients) and the incidence has been increasing.[1] Estimates indicate approximately 600 thousand new cases of sepsis each year in Brazil, with an approximate cost of US$ 9.6 thousand per patient.[2] This is a life-threatening organic dysfunction caused by a harmful systemic response secondary to infection. Risk factors include diabetes, underlying pancreatic or hepatobiliary disease and liver transplant.[6] Such abscesses commonly occur due to direct dissemination caused by peritonitis or infection of the bile ducts or, indirectly, secondary to hematogenic dissemination. Pyogenic liver abscess in pregnancy and puerperium is an extremely serious and rare complication that should be considered in the occurrence of fever accompanied by upper abdominal pain and hepatomegaly. Fernando Figueira (IMIP) (certificate number: 48398715.6.0000.5201) and was described only after the patient signed a statement of informed consent
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