Acute chorioamnionitis complicated with symmetrical peripher
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A 33-year-old female (gravida 5, para 2) was admitted with PPROM at a gestational age of 20 weeks and four days. She received the procedure of cervical cerclage due to cervical incompetence four days ago. There was not any prior history of cold or heat intolerance, tobacco smoking, diabetes, collagen vascular disease or similar family history in this patient. Treatment with the antibiotic regimen, ampicillin 2000 mg Q6H, and erythromycin 250 mg Q6H, for PPROM, was initiated. Seven days after the diagnosis of PPROM (gestational age: 21 weeks and four days), she developed fever, chills, nausea, tachypnea, and tachycardia.

The laboratory study revealed leukocytosis (20.4 × 103/?L) and inflammatory parameters were elevated (CRP 16.74). Clinical diagnosis of sepsis was determined; termination of pregnancy was decided. There was no ergot alkaloids agent used in this case. After the abortus was delivered, septic shock then occurred. In this case, inotropic agent was not prescribed but gangrene change on the nose was first noted. Afterwards, the patient developed acrocyanosis of the extremities and progressed with warm and palpable pulse. Laboratory data revealed thrombocytopenia, prolonged coagulation times, elevated D-dimers, low fibrinogen and impaired renal function. Cultures including blood sampling and the placenta obtained during delivery were performed.

Blood culture, endometrium culture and cervical bacterial culture revealed the presence of Escherichia coli. Pathology study of placenta demonstrated acute chorioamnionitis. After intensive care, clinical condition and renal function gradually improved. She then received hyperbaric oxygen therapy for peripheral gangrene and regional fasciectomy for left forearm during hospitalization . Due to stable condition and the improvement of renal function, she was then discharged and kept on hyperbaric oxygen therapy at the outpatient department.