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Cryptococcal Septic Abortion in an Immunocompetent Pregnancy: A Rare and Complex Case

Mazeki R

Background: Cryptococcal septic abortion is an exceedingly rare and life-threatening condition in immunocompetent pregnant women. This case report highlights the diagnostic and management challenges faced when encountering such an uncommon presentation.

Case Presentation: A 28-year-old previously healthy woman in her 12th week of gestation presented to the emergency department with a high-grade fever, severe lower abdominal pain, and vaginal bleeding. Initial evaluation revealed a positive urine pregnancy test and laboratory findings indicative of septic shock. An emergent ultrasound demonstrated an intrauterine pregnancy with fetal demise and an associated collection of gas and fluid. Surgical intervention, including dilation and curettage, was performed immediately, and intraoperative findings confirmed a necrotic fetus with purulent material in the uterus.

Microbiological evaluation identified Cryptococcus neoformans as the causative organism. Cryptococcal septic abortion is a rare manifestation of Cryptococcus neoformans infection, primarily associated with immunocompromised individuals. The presentation in this immunocompetent pregnant patient is an extraordinary occurrence. The management was multidisciplinary, involving obstetricians, infectious disease specialists, and intensivists. Intravenous amphotericin B and flu cytosine were initiated promptly, followed by consolidation therapy with fluconazole. The patient's clinical condition improved gradually, and she was discharged after several weeks with counseling regarding future pregnancies.