Reversible Sepsis-Induced Myocardial Dysfunction in Term Pregnancy: A Case Report of a Rare Medical Condition

Sepsis-induced myocardial dysfunction (SIMD) is a reversible heart failure that occurs during sepsis or septic shock. Although rare in pregnancy, its clinical presentation can be very similar to other peripartum heart complications, making diagnosis difficult. We report a previously healthy 28-year-old primigravida woman at 38 weeks of gestation who presented with an acute onset of dyspnea (New York Heart Association Class IV). The patient had developed upper respiratory tract symptoms approximately seven days prior to admission, including fever and malaise, which progressively worsened. A nonspecific, blanching maculopapular rash on the trunk and extremities was noted on physical examination. An emergency cesarean section was performed due to clinical deterioration of the mother and fetal distress. Postnatal echocardiography showed a left ventricular ejection fraction (LVEF) of 38% and global hypokinesia, but no apical ballooning or regional wall motion abnormalities. Radiological evidence of pneumonia, in combination with elevated inflammatory markers (high-sensitivity C-reactive protein, procalcitonin, leukocytosis) and increased cardiac biomarkers (troponin, N-terminal pro-B-type natriuretic peptide), supported the diagnosis of SIMD. Targeted antibiotic therapy, cautious fluid management, and low-dose norepinephrine were administered. Rapid improvement in heart function was observed after infection control, with LVEF returning to 55% before discharge. In cases of acute heart failure associated with sepsis during pregnancy, SIMD should always be considered in the differential diagnosis. Early detection, appropriate infection treatment, and prompt hemodynamic support can greatly improve maternal and neonatal outcomes.