Limits...
Unexplained persistent postpartum palpitations and tachycardia due to Group A Streptococcus.

Keller NA, Guan X, Wiczulis A, Burcher P - BMC Res Notes (2015)

Bottom Line: Consequent late diagnosis of invasive Group A Streptococcus infection lead to significantly increased morbidity including toxic shock syndrome, acute renal failure, total abdominal hysterectomy and bilateral salpingo-oophorectomy, multiple laparotomies, fasciotomy, intubation, continuous renal replacement therapy, and extensive hospital course and recovery.Persistent palpitations with unexplained tachycardia in the post-partum patient in the Emergency Room setting is a potential early warning of Group A Streptococcus infection.Even in the absence of reported clinical fever, uterine tenderness, or vaginal discharge, an early speculum and pelvic exam, with or without consultation with the obstetrics service, is prudent due to the potentially high morbidity or even fatality of Group A Streptococcus infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Albany Medical Center, 16 New Scotland Avenue, Second Floor, MC-74, Albany, NY, 12208, USA. kellern@mail.amc.edu.

ABSTRACT

Background: Group A Streptococcus is one of the most morbid infections in modern obstetric practice. Pregnant women are known to have a 20-fold increased risk of invasive Group A Streptococcus with greatest risk in the first 4 days postpartum. The overwhelming majority of these infections will present with fever, uterine tenderness, or vaginal discharge. A much smaller subset may present to the Emergency Room after initial hospital discharge with much less obvious symptoms. In our case, persistent palpitations with unexplained tachycardia led to improper diagnosis in multiple Emergency Rooms.

Case presentation: A 37 year-old Caucasian female presents with four post-partum days of unexplained sinus tachycardia and absence of fever, uterine tenderness, or vaginal discharge, which elicits an extensive cardiac and pulmonary workup in multiple Emergency Rooms. Consequent late diagnosis of invasive Group A Streptococcus infection lead to significantly increased morbidity including toxic shock syndrome, acute renal failure, total abdominal hysterectomy and bilateral salpingo-oophorectomy, multiple laparotomies, fasciotomy, intubation, continuous renal replacement therapy, and extensive hospital course and recovery.

Conclusion: Persistent palpitations with unexplained tachycardia in the post-partum patient in the Emergency Room setting is a potential early warning of Group A Streptococcus infection. Even in the absence of reported clinical fever, uterine tenderness, or vaginal discharge, an early speculum and pelvic exam, with or without consultation with the obstetrics service, is prudent due to the potentially high morbidity or even fatality of Group A Streptococcus infection.

No MeSH data available.


Related in: MedlinePlus

Left forearm intraoperative photograph #2. Left forearm status post decompressive fasciotomy of the flexor and extensor compartments as well as carpel tunnel release with median nerve neurolysis—zoomed view for scaling purposes
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4666222&req=5

Fig2: Left forearm intraoperative photograph #2. Left forearm status post decompressive fasciotomy of the flexor and extensor compartments as well as carpel tunnel release with median nerve neurolysis—zoomed view for scaling purposes

Mentions: In the forty-eight hours after the TAHBSO, she developed an acute kidney injury with a creatinine spike of 1.8 mg/dL, urine output of approximately 30 cc/hr, and significant metabolic acidosis. She was started on continuous renal replacement therapy, and required this for the next 5 days. Vasopressors were utilized for a total of 4 days after the TAHBSO. Six days after the TAHBSO the patient was extubated in the SICU. Seven days after the TAHBSO, she began to develop compartment syndrome in her left forearm as well as paresthesias on the left median nerve distribution. She was consequently taken to the OR for a decompressive fasciotomy of the forearm, flexor and extensor compartments as well as carpel tunnel release with median nerve neurolysis (Figs. 1, 2). Finally, 13 days after the TAHBSO she was transferred out of the SICU to a floor bed where she remained for two more weeks before discharge. At discharge, the patient was to have extensive physical, occupational, and recreational therapy. Patient was feeling well upon discharge and had been following with multiple specialty clinics.Fig. 1


Unexplained persistent postpartum palpitations and tachycardia due to Group A Streptococcus.

Keller NA, Guan X, Wiczulis A, Burcher P - BMC Res Notes (2015)

Left forearm intraoperative photograph #2. Left forearm status post decompressive fasciotomy of the flexor and extensor compartments as well as carpel tunnel release with median nerve neurolysis—zoomed view for scaling purposes
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4666222&req=5

Fig2: Left forearm intraoperative photograph #2. Left forearm status post decompressive fasciotomy of the flexor and extensor compartments as well as carpel tunnel release with median nerve neurolysis—zoomed view for scaling purposes
Mentions: In the forty-eight hours after the TAHBSO, she developed an acute kidney injury with a creatinine spike of 1.8 mg/dL, urine output of approximately 30 cc/hr, and significant metabolic acidosis. She was started on continuous renal replacement therapy, and required this for the next 5 days. Vasopressors were utilized for a total of 4 days after the TAHBSO. Six days after the TAHBSO the patient was extubated in the SICU. Seven days after the TAHBSO, she began to develop compartment syndrome in her left forearm as well as paresthesias on the left median nerve distribution. She was consequently taken to the OR for a decompressive fasciotomy of the forearm, flexor and extensor compartments as well as carpel tunnel release with median nerve neurolysis (Figs. 1, 2). Finally, 13 days after the TAHBSO she was transferred out of the SICU to a floor bed where she remained for two more weeks before discharge. At discharge, the patient was to have extensive physical, occupational, and recreational therapy. Patient was feeling well upon discharge and had been following with multiple specialty clinics.Fig. 1

Bottom Line: Consequent late diagnosis of invasive Group A Streptococcus infection lead to significantly increased morbidity including toxic shock syndrome, acute renal failure, total abdominal hysterectomy and bilateral salpingo-oophorectomy, multiple laparotomies, fasciotomy, intubation, continuous renal replacement therapy, and extensive hospital course and recovery.Persistent palpitations with unexplained tachycardia in the post-partum patient in the Emergency Room setting is a potential early warning of Group A Streptococcus infection.Even in the absence of reported clinical fever, uterine tenderness, or vaginal discharge, an early speculum and pelvic exam, with or without consultation with the obstetrics service, is prudent due to the potentially high morbidity or even fatality of Group A Streptococcus infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Albany Medical Center, 16 New Scotland Avenue, Second Floor, MC-74, Albany, NY, 12208, USA. kellern@mail.amc.edu.

ABSTRACT

Background: Group A Streptococcus is one of the most morbid infections in modern obstetric practice. Pregnant women are known to have a 20-fold increased risk of invasive Group A Streptococcus with greatest risk in the first 4 days postpartum. The overwhelming majority of these infections will present with fever, uterine tenderness, or vaginal discharge. A much smaller subset may present to the Emergency Room after initial hospital discharge with much less obvious symptoms. In our case, persistent palpitations with unexplained tachycardia led to improper diagnosis in multiple Emergency Rooms.

Case presentation: A 37 year-old Caucasian female presents with four post-partum days of unexplained sinus tachycardia and absence of fever, uterine tenderness, or vaginal discharge, which elicits an extensive cardiac and pulmonary workup in multiple Emergency Rooms. Consequent late diagnosis of invasive Group A Streptococcus infection lead to significantly increased morbidity including toxic shock syndrome, acute renal failure, total abdominal hysterectomy and bilateral salpingo-oophorectomy, multiple laparotomies, fasciotomy, intubation, continuous renal replacement therapy, and extensive hospital course and recovery.

Conclusion: Persistent palpitations with unexplained tachycardia in the post-partum patient in the Emergency Room setting is a potential early warning of Group A Streptococcus infection. Even in the absence of reported clinical fever, uterine tenderness, or vaginal discharge, an early speculum and pelvic exam, with or without consultation with the obstetrics service, is prudent due to the potentially high morbidity or even fatality of Group A Streptococcus infection.

No MeSH data available.


Related in: MedlinePlus