Akhanoba Folasade, MacDougall Jane, Mathur Raj, Hassan Wassim
Department of Obstetrics and Gynaecology, Addenbrooke's Hospital, Cambridge, UK.
BMJ Case Rep. 2014 Mar 31;2014:bcr2013203202. doi: 10.1136/bcr-2013-203202.
A 41-year-old nulliparous woman, with a medical history of unexplained infertility and multiple in vitro fertilisation (IVF) cycles with immunosuppressive therapy, was admitted to our tertiary obstetrics unit with sepsis at 18 weeks of pregnancy with dichorionic diamniotic twins. Candida glabrata was grown from her blood cultures, then subsequently from the liquor and placentae. She was treated with intravenous ambisome (amphotericin), but unfortunately, the infection resulted in the rupture of her membranes, preterm labour and the demise of her twins. She delivered both twins at 23 weeks, 3 days apart. The antifungal agent was changed to high-dose fluconazole after delivery for 2 weeks and she is now well. Women undergoing IVF-embryo transfer with immunomodulation therapy have a potential risk of developing candidal chorioamnionitis and sepsis.
一名41岁未生育女性，有不明原因不孕症病史且接受过多次体外受精（IVF）周期及免疫抑制治疗，怀孕18周时因双绒毛膜双羊膜囊双胎并发败血症入住我们的三级产科病房。其血培养分离出光滑念珠菌，随后羊水和胎盘也培养出该菌。她接受了静脉注射两性霉素B脂质体（两性霉素）治疗，但不幸的是，感染导致胎膜破裂、早产，双胎死亡。她在23周时分娩了两个胎儿，间隔3天。产后抗真菌药物改为大剂量氟康唑，持续2周，她现在情况良好。接受免疫调节治疗的IVF胚胎移植女性有发生念珠菌性绒毛膜羊膜炎和败血症的潜在风险。
