Necrotizing Fasciitis in the Puerperium of a Woman with Complement Deficiency: Case Report and Review Literature

• 作者: Amanda Vilaverde Perez Daniela Vanessa Vettori Edimárlei Gonsales Valério Gustavo Adolpho Moreira Faulhaber Janete Vettorazzi Mariana Sbaraini
• 来源期刊: 妇产科期刊(英文)
• 学科: 医学
• 关键词: Pregnancy IMMUNODEFICIENCY C4 Factor C4 Deficiency NECROTIZING FASCIITIS Puerperal Infection
• 年，卷（期）: 2018,（12）
• 页码范围: 1236-1246
• 页数: 11页
• 分类号: R73

摘要

Complement deficiencies are uncommon types of primary immunodeficiency. Necrotizing fasciitis is a rare complication in pregnancy characterized by soft tissue invasion and necrosis of the subcutaneous and other adjacent tissues, leading to high mortality rates. We report a case of a 29-year-old pregnant woman with functional deficiency of the C4 complement component and short uterine cervix. Admitted at the hospital with preterm labor, she received multiple doses of immunoglobulin. After 8 weeks, she had a premature membrane rupture, and due to pelvic presentation she had a cesarean. The patient presented multiple obstetric complications, such as operative wound infection, endometritis, sepsis, necrotizing fasciitis and pelvic septic thrombophlebitis. She underwent multiple antimicrobial schemes, a hysterectomy and 4 extensive debridements of the abdominal wall because of significant necrosis. She stayed at the hospital for 101 days (32 of those in ICU in immediate postpartum). 41 days after cesarean, patient was discharged in good conditions. Our case emphasizes individual handling and high multiple doses of immunoglobulin for favorable outcome of the case.