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n e w e ng l a n d j o u r na l


m e dic i n e

case records of the massachusetts general hospital
Founded by Richard C. Cabot Nancy Lee Harris, m.d., Editor Eric S. Rosenberg,m.d., Associate Editor Jo-Anne O. Shepard, m.d., Associate Editor Alice M. Cort, m.d., Associate Editor Sally H. Ebeling, Assistant Editor Christine C. Peters, Assistant Editor

Case 35-2011: A33-Year-Old Woman with Postpartum Leukocytosis and Gram-Positive Bacteremia
David E. Soper, M.D., Susanna I. Lee, M.D., Ph.D., Ji Yeon Kim, M.D., M.P.H., and Anna G. McDonald, M.D.

Pr e sen tat ion of C ase
From the Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston (D.E.S.); and the Departments of Radiology (S.I.L.) and Pathology (J.Y.K., A.G.M.),Massachusetts General Hospital, and the Departments of Radiology (S.I.L.) and Pathology (J.Y.K., A.G.M.), Harvard Medical School — both in Boston. N Engl J Med 2011;365:1916-24.
Copyright © 2011 MassachusettsMedical Society.

Dr. Edwin C. Huang (Obstetrics and Gynecology): A 33-year-old woman was admitted to the intensive care unit (ICU) at this hospital 16.5 hours post partum because of leukocytosis andgram-positive rods in the blood. The patient had received routine prenatal care at this hospital. At 5 and 7 weeks of gestation, ultrasonography performed because of intermittent vaginal bleeding wasreported to reveal an arcuate uterus with findings suggestive of a cornual ectopic pregnancy. At that time, diagnostic laparoscopy revealed no evidence of an ectopic pregnancy. Repeat ultrasoundexaminations at 8 and 9 weeks showed a normal uterus and fetus, with a subchorionic hematoma that appeared to be resolving. Ultrasound examination at 18 weeks was normal. Screening for syphilis and thehuman immunodeficiency virus and a urine culture were negative. Two weeks before admission, the patient noted increased fatigue and dizziness. One week later, at 36 weeks of gestation, the blood...
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