Maternal Death Due to Clostridium novyi in an Injection Drug User.
BACKGROUND
Soft-tissue infections in women with subcutaneous injection drug use are often polymicrobial.


METHODS
A 21-year-old nulliparous woman presented at 14-15 weeks of gestation with several gluteal abscesses related to subcutaneous injection of heroin. She was well appearing, afebrile, and without findings of systemic illness. After empiric broad-spectrum intravenous antibiotics, same-day incision and drainage was performed. Immediately after the procedure, she developed refractory hypotension, severe tachycardia, pulmonary edema, and leukemoid reaction (white blood cell count 80×10/L). Cardiac arrest ensued, and she died within 4 hours of onset of sepsis and within 24 hours of presentation. Wound cultures identified Clostridium novyi.


CONCLUSIONS
Local, soft-tissue infections that includes C novyi can result in rapidly fatal, toxin-mediated septic shock in pregnant women with high-risk social behavior.
Departments of Obstetrics and Gynecology, Surgery, and Pathology, University of Texas Southwestern Medical Center, and Southwestern Institute of Forensic Sciences, Dallas, Texas.
Christina
C
Herrera
Ryan
R
Meehan
Varsha
V
Podduturi
Alexander L
AL
Eastman
David B
DB
Nelson
D003015:Clostridium Infections / Q000175:diagnosis*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006556:Heroin Dependence; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011261:Pregnancy Trimester, First; D011296:Prenatal Diagnosis; D018461:Soft Tissue Infections / Q000175:diagnosis*; D055815:Young Adult