Laparoscopic-endoscopic rendez-vous resection of iuxta-cardial gastric GIST.

BACKGROUND

Septic shock in the postpartum period is a life-threatening condition associated with significant mortality. The physiological changes of pregnancy and the puerperium often complicate diagnosis and treatment, making timely, effective intervention critical. When conventional antimicrobial therapy fails, alternative therapeutic strategies become essential. Recent systematic reviews have highlighted the potential benefits of IgM-enriched immunoglobulin in reducing mortality among sepsis patients.

CASE DESCRIPTION: We report the case of a 25-year-old previously healthy woman who developed severe septic shock following caesarean section delivery. The clinical picture was complicated by influenza A pneumonia and a urinary tract infection caused by Escherichia coli. Despite administration of broad-spectrum standard antimicrobial treatments, the patient exhibited rapid clinical deterioration, with escalating vasopressor requirements and severe hyperinflammation. Biomarkers were profoundly elevated, including a procalcitonin level of 386.2 ng/ml and a C-reactive protein of 424 mg/l. Given the failure of standard therapy and the critical condition, IgM-enriched immunoglobulin (Pentaglobin®) was administered as a rescue therapy. Within 24 hours of infusion, the patient demonstrated significant clinical and biochemical improvement, with normalisation of vital signs, reduced inflammatory markers and early weaning from vasopressors. She achieved full recovery and rapid hospital discharge.

CONCLUSION

This case highlights the potential life-saving role of IgM-enriched immunoglobulin and its potential therapeutic value in managing refractory postpartum sepsis and severe community-acquired pneumonia (CAP). While promising, the timing, dosage and patient selection for this therapy require further clinical investigation, particularly in obstetric populations.

LEARNING POINTS: IgM-enriched immunoglobulin therapy represents a viable adjunctive option for refractory sepsis, particularly in hyperinflammatory presentations. Early therapeutic intervention within 24 hours of refractory status may optimise clinical outcomes.Phenotype-based therapy selection can identify patients most likely to benefit from immunomodulatory interventions. Postpartum patients may experience worse outcome due to pregnancy-related immune modifications.Biomarker monitoring including procalcitonin and C-reactive protein can guide therapeutic decisions and evaluate treatment response.