title: Fulminant puerperal sepsis due to anaplastic large-cell lymphoma (ALCL) with therapy-refractory cerebral edema.
abstract: BACKGROUND
  Lymphoma is among the five most frequent malignancies during pregnancy while anaplastic large-cell lymphoma (ALCL) is rare, accounting only for 2-3 % of all adult-onset non-Hodgkin lymphomas.
  
  
  METHODS
  A 23-year-old gravida 1, para 1 presented with puerperal mastitis and septicemia following secondary cesarean section. Mastitis had been present for a week prior to delivery. A CT scan for further diagnostics revealed numerous prominent lymph nodes. Cerebrospinal fluid testing, bone marrow and lymph node biopsy confirmed diagnosis of ALCL. Systemic and intrathecal chemotherapy was initiated, stabilizing the patient's clinical situation. 30 days postpartum (pp.), a cerebral edema was diagnosed responsible for cerebro-venous hypoperfusion. Immediate ventricle drainage and further therapeutic measures revealed no improvement. The patient died 33 days pp.
  
  
  CONCLUSIONS
  Puerperal septicemia seemingly caused by mastitis still needs rapid further evaluation if the patient's clinical presentation quickly declines despite antibiotic therapy. Immediate initiation of chemotherapy after confirmation of ALCL is required to increase the therapeutic benefit due to the poor prognosis of ALCL.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany, nfreerksen@ukaachen.de.
authors.forename: Nele
authors.initials: N
authors.lastname: Freerksen
authors.forename: Martin
authors.initials: M
authors.lastname: Kirschner
authors.forename: Ulrich
authors.initials: U
authors.lastname: Pecks
authors.forename: Saskia
authors.initials: S
authors.lastname: Westphal
authors.forename: Edgar
authors.initials: E
authors.lastname: Jost
authors.forename: Nicolai
authors.initials: N
authors.lastname: Maass
authors.forename: Dirk O
authors.initials: DO
authors.lastname: Bauerschlag
mesh_terms: D000328:Adult; D001706:Biopsy; D001929:Brain Edema / Q000188:drug therapy / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017728:Lymphoma, Large-Cell, Anaplastic / Q000188:drug therapy / Q000473:pathology*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy / Q000473:pathology*; D018805:Sepsis / Q000150:complications / Q000473:pathology* / Q000628:therapy