Maternal Death due to Viral Sepsis

Sepsis accounts for approximately 10% of all maternal deaths and in pregnancy, as a result of cell-mediated immunity is altered and prone for infection. Varicella zoster virus (VZV) commonly causes chickenpox in children and herpes zoster in adults. In this case, viral sepsis probably due to VZV has caused a death of an apparently immune-competent young mother. A 19-year-old unmarried sex worker with Grave’s disease presented in her second trimester with ankle oedema and shortness of breath.  She was hypertensive and anaemic and was treated for secondary hypertension due to thyrotoxicosis. Later, she developed fever, oliguria and heart failure. She was treated in intensive care unit with hyperthyroid crisis induced by sepsis due to pneumonia. She developed high fever, intra-uterine death, hepato-renal failure, disseminated intravascular coagulation (DIC) and died on day fourteen. At autopsy, dermotomal vesicular skin lesions and vulval viral warts were seen. The internal organs showed sepsis. Blood for HIV was negative. Histopathology revealed viral pneumonia, myocarditis and DIC. Cause of death was given as sepsis due to viral pneumonia probably following VZV. The clinical diagnosis was septicaemia, due to pneumonia, but herpes zoster infection was not diagnosed. VZV infection can be life threatening even in immune-competent adults. The diagnosis of multi-organ failure from VZV should always be clinically suspected in the presence of atypical skin lesions and a temporarily immune-compromised state such as pregnancy.