Re: baffling case
From: Anna Meenan, MD (annam@uic.edu)
Tue May 31 21:58:45 2005
Gallium scan?
--
Anna Meenan, MD
At Tue, 31 May 2005, Richard Chudacoff, MD wrote:
>
>21 yo G1, GBS negative, admitted through the midwife service 12 days ago.
>She arrested in dilation, after IUPC and FSE, and underwent an unremarkable
>low transverse c-section via Pfannenstiel skin incision 10 days ago. 36
>hours post-op she spike to 103 degrees F and hand a tender uterus, and was
>started on Ampicillin, gentamycin and clindamycin (by the resident on call)
>for post partum endomyometritis. 48 hours post op she was still febrile. ID
>was consulted, after another exam which noted a still tender uterus and she
>was switched to vancomycin and meropenem to cover MRSA as well as the
>usually culprits. She has a history of IBD and grew out C. diff on stool
>culture and was started on Flagyl. She also started taking scheduled Motrin
>and Tylenol. She defervesced for 36 hours and the antibiotics were stopped,
>except for the Flagyl, as were the anti-pyretics. 4 hours later she spiked
>to 103. Antibiotics and anti-pyrectis were restarted. Pelvic U/S was
>negative. KUB to r/o foreign body was negative. CT of pelvis was negative,
>as was chest x-ray, blood cultures and urine culture (from the original
>workup) and all subsequent cultures have been negative. She defervesed, and
>was stable for 24 hours. Anti-pyrectics were stopped 48 hours ago, and she
>then spiked again, despite being on anti-biotics. Repeat CT is negative, as
>is repeat CXR. Doppler studies of the lower extremities are negative, with
>great flow bilaterally. GI consults negative. No evidence of cardiac valve
>abnormalities ruling out SBE.
>
>I'm thinking that the only thing left to try is heparin for septic pelvic
>thrombophelbitis or septic gonadal thrombophelbitis. I thought she might
>have a drug fever, however she did spike after discontinuation of the wonder
>drugs.
>
>Any thoughts, pearls, questions, and acceptance of transfer to your service
>would be appreciated.
>
>--
>Richard Chudacoff, MD, FACOG
>
>Women's Specialists of Houston
>
>6624 Fannin Suite 1800
>
>Houston, TX, 77030
>
>713-797-1144
>
>713-425-3071
>
>Email: Richard.Chudacoff@obgyn.net
>
> rchudacoff.md@womenspecialists.com
>
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