Obstructive urinary tract infection-related septic shock in late pregnancy complicated by β-thalassemia intermedia and whipworm infection: a case report.

BACKGROUND

Sepsis is a leading cause of maternal mortality. Diagnosis in pregnancy is often delayed by non-specific symptoms and legitimate caution regarding diagnostic imaging. This case illustrates a complex diagnostic challenge: septic shock in a migrant woman, where unfamiliar, endemic comorbidities obscured the typical clinical picture. CASE PRESENTATION: An 18-year-old primigravida at 26 + 5 weeks’ gestation presented with fever and mild respiratory symptoms, which rapidly progressing to septic shock. Initial labs revealed severe microcytic anemia (hemoglobin 59 g/L), marked hyperbilirubinemia, and leukocytosis. A low-dose chest-abdomen CT scan, crucial for source identification, revealed right-sided obstructive uropathy. This led to a diagnosis of obstructive urinary tract infection as the septic focus, managed with urgent ureteral stenting and antibiotics therapy. Further investigation unmasked two underlying conditions contributing to her severe anemia: homozygous β-thalassemia intermedia and chronic Trichuris trichiura infection. The jaundice was attributed to hepatocellular dysfunction induced by sepsis. Following source control, transfusions, and supportive care, both maternal and fetal conditions stabilized.

CONCLUSION

This case underscores the importance of timely imaging for source control in pregnant patients with sepsis and atypical laboratory findings. It also highlights the need to consider region-specific hereditary and parasitic diseases in the differential diagnosis for migrant populations, as these can complicate clinical presentation and management.