Acute postpartum pleural effusion causing distress for patient and obstetrician

Authors

  • G. K. Poomalar Department of Obstetrics and Gynaecology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
  • Padmapriya S. Department of Obstetrics and Gynaecology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
  • Bupathy . Department of Obstetrics and Gynaecology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
  • R. Praveen Department of Respiratory Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20241460

Keywords:

Pregnancy, Postpartum, Pleural effusion, Immune reconstitution syndrome

Abstract

A 31-year-old Gravida 5 Para 2 Live 2 Abortion 2, without comorbidities, underwent spontaneous vaginal delivery at term. She was asymptomatic in postpartum and had puerperal sterilization under low risk on postnatal day 4. After fourteen hours of surgery, she experienced an acute onset of breathlessness, tachypnea, and orthopnoea. Workup revealed right-sided pleural effusion filling three-fourths of the cavity with consolidation on chest X- ray. Therapeutic thoracocentesis was performed draining 600 ml of straw-coloured fluid. She was started on the Piperacillin tazobactam combination. Due to the repeated collection and persistent symptoms, a continuous intercostal drain was placed after 4 days. Due to persistent fever spikes, antibiotics were stepped up to Linezolid and Meropenem. A negative result on the Mantoux test, CBNAAT, and IGRA test was obtained. ANA profiling revealed the presence of non-specific KU antibodies. Symptomatic improvement was noted, and the ICD was subsequently removed after 6 days of insertion. Pregnancy is an immunosuppressive state. Rapid reversal of this state in postpartum results in a flare-up of quiescent infection. Even auto-immune diseases flare up in postpartum. Understanding this phenomenon of immune reconstitution syndrome and its impact will help in the management planning of postpartum women without dilemmas.

References

Singh N, John R. Perfect, Immune Reconstitution Syndrome and Exacerbation of Infections after Pregnancy. Clin Infect Dis. 2007;45:9.

Saha BK, Chieng H, Chong WH. An unusual case of explosive pleuritis without mediastinal shift. Am J Med Sci. 2022;364(1):92-8.

Sharma JK, Marrie TJ. Explosive pleuritis. Can J Infect Dis. 2001;12(2):104-7.

Riley L, Karki A, Mehta HJ, Ataya A. Obstetric and gynecologic causes of pleural effusions. Dis Mon. 2019;65(4):109-14.

Gourgoulianis KI, Karantanas AH, Diminikou G, Molyvdas PA. Benign postpartum pleural effusion. Eur Respir J. 1995;8(10):1748-50.

Udeshi UL, McHugo JM, Crawford JS. Postpartum pleural effusion. Br J Obstet Gynaecol. 1988;95(9):894-7.

Singh N, Perfect JR. Immune reconstitution syndrome and exacerbation of infections after pregnancy. Clin Infect Dis. 2007;45(9):1192-9.

Elenkov I, Wilder R, Bakalov V. IL-12, TNF-alpha, and hormonal changes during late pregnancy and early postpartum: implications for autoimmune disease activity during these times. J Clin Endocrinol Metab. 2001;86:4933-8.

Cheng VC, Woo PC, Lau SK, Cheung CH, Yung RW, Yam LY, et al. Peripartum tuberculosis as a form of immunorestitution disease. Eur J Clin Microbiol Infect Dis. 2003;22(5):313-7.

Downloads

Published

2024-05-29

Issue

Section

Case Reports