The new mother had a normal recovery from childbirth. But a month later, she was beset by debilitating symptoms.
The 28-year-old woman had just put her 6-week-old baby down for a nap when the now familiar sensations began. Cold descended on her body as if it were a frigid January in their small town of Bettendorf, Iowa, and not a golden April morning. Her teeth chattered and her arms and legs shook and jerked, shivering to heat this self-made winter. Minutes later the cold disappeared, replaced by an achy heaviness and heat. A thermometer confirmed what the new mother and her husband already knew. Her fever was back.
This had been a pattern, once or twice a day, for the past two weeks: bone-rattling cold quickly replaced by the heat of fevers that rose to 102 or 103 degrees and lasted until vanquished by acetaminophen. She already had been to the urgent-care center in Moline, Ill., just across the Mississippi River, where she was given a 10-day course of antibiotics. But that day she would take the last dose, and still the intermittent fevers raged on. Even when they subsided, as they always did, she still had some pain between her legs from the stitches she received when the baby was born. That pain disappeared a few days after she got home but suddenly reappeared with her fevers — a full month after her delivery.
That morning the worried young parents packed up their baby and headed to the OB-GYN clinic at the University of Iowa Health Care Medical Center in Iowa City where they had a previously scheduled follow-up visit.
Searching for an Infection
The midwife listened to their story and then gently examined the woman. It was clear that some of the stitches hadn’t held, and the torn skin, carefully sutured at the time of the birth, had reopened, oozing purulence in a couple of places. The whole area was exquisitely tender. She was admitted to the hospital and immediately started on two broad-spectrum intravenous antibiotics.
The next day, she was taken to an operating room and put to sleep so that the region could be examined more fully. Under the bright lights of the O.R., it was clear that the open areas of the suture line had been infected, but after the antibiotics, they appeared to be healing well. An examination of the cervix was unremarkable. Nor did her breasts show any signs of the inflammation that can complicate breastfeeding. It was all very reassuring to her doctors. And yet she continued to have these dramatic daily fevers as she remained in the hospital.
So where was the infection? Cultures from the surgical site were uninformative. Samples of her blood and urine grew no bacteria. A CT scan didn’t show any hidden areas of inflammation or clots that might have been seeded with germs. And the patient herself had no other complaints.