Neutropenic sepsis and CMV-induced haemophagocytic lymphohistiocytosis in the postpartum period.

A postpartum woman in her 40s, with a history of peripartum cardiomyopathy, developed neutropenic sepsis after a caesarean section and hysterectomy for placenta previa. She presented with high fever, respiratory distress, and splenomegaly, along with severe neutropenia (absolute neutrophil count <100 cells/mm³). Blood cultures showed coagulase-negative staphylococci, and viral tests were positive for cytomegalovirus (CMV). A suspected complication of haemophagocytic lymphohistiocytosis (HLH) following CMV infection was considered. Broad-spectrum antibiotics, corticosteroids, granulocyte-macrophage colony-stimulating factor and intravenous immunoglobulin were administered. There was marked improvement as the patient became afebrile, with the return of neutrophils and stabilisation of her vital parameters. Follow-up at 3 and 6 months post-admission showed that the patient remained clinically improved with no subsequent complications. This case highlights the challenging management of neutropenic sepsis complicated by HLH provoked by CMV in a postpartum woman.