TITLE:
Necrotizing Fasciitis in the Puerperium of a Woman with Complement Deficiency: Case Report and Review Literature
AUTHORS:
Janete Vettorazzi, Edimárlei Gonsales Valério, Gustavo Adolpho Moreira Faulhaber, Amanda Vilaverde Perez, Mariana Sbaraini, Daniela Vanessa Vettori
KEYWORDS:
Pregnancy, Immunodeficiency, C4 Factor, C4 Deficiency, Necrotizing Fasciitis, Puerperal Infection
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.12,
October
26,
2018
ABSTRACT: 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.