A case of peripartum cardiomyopathy due to fulminant infection with streptococcus pyogenes

We experienced an ICU case of peripartum cardiomyopathy due to severe streptococcal infection. A 25-year-old woman complained of severe abdominal pain 2 months after cesarean section. A diagnosis of peritonitis was made and laparotomy with intraabdominal lavage and drainage were performed. Although no abnormalities were detected in the visceral organs, we observed a large quantity of purulent ascites. Immediately after surgery, the patient was admitted to the ICU for intensive care of septic shock. Since severe streptococcal infection was suspected on the basis of clinical symptoms, administration of ampicillin and gentamicin were commenced before obtaining microbiological confirmation. Moreover as peripartum cardiomyopathy was also suspected 2 days after admission to the ICU, PDEIII inhibitor administration was commenced. After confirmation of the diagnosis of severe streptococcal infection, these antibacterial therapies were continued and plasma exchange was started as well. The patient showed favorable progress, resulting in discharge from the ICU 8 days after arrival. In this patient, combination therapy with the administration of ampicillin and gentamicin, plasma exchange therapy, and continuous therapy with PDEIH inhibitors, were effective in the treatment of severe streptococcal infection following peripartum cardiomyopathy.