Case 21-2021: A 33-Year-Old Pregnant Woman with Fever, Abdominal Pain, and Headache

his case report describes a 33 year old pregnant woman with ulcerative colitis who presented at 10 weeks of gestation with fever, nausea, vomiting, abdominal pain, and headache. The patient had a history of intermittent immunosuppressive therapy for ulcerative colitis and recent hospitalization for a disease flare. Initial evaluation revealed no evidence of colitis on imaging, but blood cultures identified Listeria monocytogenes bacteremia. Despite antibiotic therapy with ampicillin and gentamicin, fetal demise occurred at 11 weeks of gestation. Placental pathology confirmed decidual inflammation consistent with listeriosis. The case highlights the increased risk of severe Listeria infection in pregnant women, particularly those with immunosuppression, and underscores the importance of early diagnosis and treatment to mitigate adverse maternal and fetal outcomes. The discussion explores differential diagnoses, including TORCH infections, influenza, and other bacterial pathogens, while emphasizing the unique pathogenesis and complications of listeriosis in pregnancy.

his case report describes a 33 year old pregnant woman with ulcerative colitis who presented at 10 weeks of gestation with fever, nausea, vomiting, abdominal pain, and headache. The patient had a history of intermittent immunosuppressive therapy for ulcerative colitis and recent hospitalization for a disease flare. Initial evaluation revealed no evidence of colitis on imaging, but blood cultures identified Listeria monocytogenes bacteremia. Despite antibiotic therapy with ampicillin and gentamicin, fetal demise occurred at 11 weeks of gestation. Placental pathology confirmed decidual inflammation consistent with listeriosis. The case highlights the increased risk of severe Listeria infection in pregnant women, particularly those with immunosuppression, and underscores the importance of early diagnosis and treatment to mitigate adverse maternal and fetal outcomes. The discussion explores differential diagnoses, including TORCH infections, influenza, and other bacterial pathogens, while emphasizing the unique pathogenesis and complications of listeriosis in pregnancy.