Case report: group B streptococcal bacteremia and sacroiliitis after mid-trimester dilation and evacuation

Abstract

Group B streptococcal bacteremia with septic arthritis is a rare complication of second trimester dilation and evacuation, and may cause substantial post-operative morbidity. A 37-year-old gravida 4 para 1-0-2-1 presented with fever and right hip pain on post-operative day 11 from a second trimester dilation and evacuation for fetal trisomy 21. She was initially found to have septic arthritis involving the right sacroiliac joint and group B streptococcal bacteremia. Transesophageal echocardiogram showed a tricuspid valve, vegetation consistent with endocarditis. After prolonged parenteral antibiotic therapy, she developed septic pulmonary emboli that were successfully treated with anticoagulation therapy. Group B streptococcal infection is a potentially serious post-abortion complication that can cause sacroiliitis, endocarditis and septic pulmonary emboli.

Antibiotic Prophylactics on Curettage for Preventing Pelvic Inflammatory Disease Events: Is It Necessary?

“…Although rare, it is possible to develop multivalvular, right-sided, and left-sided endocarditis [19,20] or endogenous candida endophthalmitis [21]. Consideration to give antibiotic prophylaxis is for the patient which have the endocarditis or endophthalmitis risk.…”

Bilateral Erosive Septic Hip Arthritis Following Pregnancy

“…While the pain typically resolves after delivery, about 25% of patients have persistent pain longer than 3 months postpartum [ 12 , 13 ]. Septic arthritis of the hip, sacroiliac joint, and pubic symphysis have all been described following pregnancy [ [4] , [5] , [6] , [7] , [8] , 14 ]. While these entities are rare, early diagnosis is critical to prevent irreversible joint damage.…”

“…Previous case reports describe GBS septic arthritis following spontaneous abortion, dilation and evacuation, and vaginal delivery [ [4] , [5] , [6] , [7] , [8] , 14 ]. Four of these cases describe septic arthritis of the hip, 1 of which resulted in bilateral septic hip arthritis [ [5] , [6] , [7] , [8] ].…”

“…In pregnant women, GBS can result in bacteremia, urinary tract infection, endometritis, and pneumonia [ 1 ]. Less commonly, GBS can lead to endocarditis, sacroiliitis, or septic arthritis [ [2] , [3] , [4] ]. Septic arthritis of the hip following pregnancy has been described in a limited number of case reports [ [5] , [6] , [7] , [8] ].…”

Iliopsoas Abscess

“…The pathogenesis of post-D&E infections is thought to be due to the introduction of microorganisms into the upper genital tract from the lower genital tract of women [2,3,6]. Extrauterine infections still do occur, albeit exceedingly rarely and can be associated with significant maternal morbidity and mortality [1Y4].…”