Publication:

Peripartum meningoencephalitis complicated by transient stress-induced cardiomyopathy: a case report

Acute meningoencephalitis in late pregnancy is a rare, life-threatening emergency. We report a complex case of peripartum meningoencephalitis associated with severe, transient left ventricular (LV) dysfunction and postpartum delirium. A 30-year-old G2A1 at 37 weeks gestation presented with a one-week history of fever, headache, and thrombocytopenia. Her condition rapidly deteriorated into irritability, neck rigidity, and altered sensorium. MRI brain revealed features of meningoencephalitis with a right hippocampal infarct; CSF analysis showed pleocytosis. Following an emergency cesarean section, the patient developed acute heart failure with an Ejection Fraction (EF) of 20% and elevated Troponin-I (1200.7 ng/ml). She required mechanical ventilation and inotropic support with dobutamine. Management included intensive care and broad-spectrum antimicrobials (Ceftriaxone, Vancomycin, Doxycycline, and Acyclovir). Remarkably, her EF recovered gradually to 45% and 60% within 48 and 72 hours respectively, suggesting stress-induced (Takotsubo) cardiomyopathy secondary to the neurological crisis. Despite a postoperative generalized seizure and transient delirium, she showed significant recovery and was successfully extubated on post operative day 4. Follow-up CSF analysis was negative for tuberculosis and bacterial panels. She was discharged on postoperative day 15 on cardiac and antiepileptic medications. This case highlights the "perfect storm" of physiological stress triggering transient cardiac dysfunction secondary to a primary neurological insult. It underscores the necessity of a multidisciplinary approach in managing peripartum neurological emergencies, where severe cardiac impairment may be fully reversible with prompt stabilization and delivery. ivery.