40-year-old secundigesta, born in Colombia, with a history of pregnancy and previous delivery without complications that presents morbid obesity (BMI 43) and recurrent biliary colic.
At week 30+4 of gestation, the patient came to the emergency department complaining of generalized pruritus of 48 hours onset and flu-like symptoms with fever, arthromyalgia and general malaise.
Clinical examination revealed scratching lesions without urticariform lesions and febricula at 37oC.
Fetal well-being was verified by obstetric ultrasound (fetal in anterior cephalocausal, posterior normoinsemination placenta and normal amniotic fluid) and cardiotocic record (reactive pattern, adynamia).
Blood count showed no significant changes except moderate anemia (Hb 10 g/dl), elevated transaminase (AST and ALT 208 and 238 U/L) and bile acid coagulation 56.9 μmol/L.
We decided to admit the patient with gravidic acid stasis and started treatment with deoxysodeoxycholic acid at a dose of 13 mg/kg/day, loratadine 10 mg/ 24 g/tyramine.
Forty-eight hours after admission, the patient developed fever of up to 38.6 oC, cough, dyspnea and otalgia, with normal bronchopulmonary auscultation and 98% saturation.
Chest X-ray, hemocultives and nasopharyngeal swabs (PCR influenza) were requested. Empirical treatment with ampicillin 2g/4h, gentamicin 240 mg/24h and oseltamivir 75 mg was initiated.
Because of the analytical evolution and the history of biliary colic, a second ultrasound was requested, which confirmed the diagnosis of colitis.
The nasopharyngeal smear for influenza was negative and in the hemocultive was isolated Lis persistent sensitive to ampicillin, gentamicin and penicillin, so treatment with oseltamivir was suspended and
Likewise, treatment with oral iron preparations was suspended.
The patient presented a torpid evolution of stasis with partial decrease of transaminases and isolated episodes of pruritus despite treatment.
Subsequent analytical determinations showed changes with elevations and decreases in transaminases and bile acids, as shown in Table 1.
1.
The listeriosis clinical picture presented a favorable evolution, showing apyretic and tapering, with a gradual decrease in CRP levels from the beginning of antibiotic treatment.
Serial control of fetal well-being was performed by obstetric ultrasound and cardiotocographic record up to week 32+4, in which labor began spontaneously after completing 14 days of treatment with gentamicin and 7 days of treatment with ampicillin.
Intrapartum fetal well-being was verified by maternal-fetal monitoring, aiming meconium amniotic fluid.
The delivery was eutocic, obtaining a girl weighing 2,225 g, Apgar 9/10 and cord pH 7.36 arterial and 7.37 venous.
The newborn was admitted in neonatology for prematurity and history of maternal listeriosis.
Cultures performed (pharyngeal, vermis, umbilical, hemocultive, urocultive and coprocultive) were negative, being discharged at 10 days of life.
The puerperal evolution was normal and she was discharged 48 hours after delivery.
Pathological examination of the placenta showed multiple «septic» infarcts with the presence of isolated Gram-positive bacilli formations, compatible with Lis infection state.
