Obstructive urinary tract infection–related septic shock in late pregnancy complicated by β-thalassemia intermedia and whipworm infection: a case report

Background: Sepsis is a leading cause of maternal mortality. Diagnosis in pregnancy is often delayed by non-specific presentation and legitimate caution regarding diagnostic imaging.This case illustrates a compounded diagnostic challenge: septic shock in a migrant patient, where unfamiliar, endemic comorbidities obscured the typical clinical picture. Case presentation: An 18-year-old primigravida at 27 weeks’ gestation presented with fever and mild respiratory symptoms, rapidly progressing to septic shock. Initial labs revealed severe microcytic anemia (Hb 59 g/L), marked hyperbilirubinemia, and leukocytosis. A low-dose abdominopelvic CT, crucial for source identification, revealed right-sided obstructive uropathy. This led to a diagnosis of obstructive pyelonephritis as the septic focus, managed with urgent ureteral stenting and antibiotics. Further investigation unmasked two underlying conditions contributing to her severe anemia: homozygous β-thalassemia intermedia and chronic Trichuris trichiura infection. The jaundice was attributed to sepsis-induced hepatocellular dysfunction. Following source control, transfusions, and supportive care, both maternal and fetal conditions stabilized. Conclusion: This case underscores that in pregnant patients with sepsis and atypical laboratory findings, timely imaging for source control is paramount. It also highlights the critical need to consider region-specific hereditary and parasitic diseases in the differential diagnosis for migrant populations, as these can significantly complicate the clinical presentation and management.