Disseminated Herpes Simplex Virus Presenting as Postpartum Sepsis: A Rural Case Report

Purpose Infection with disseminated herpes simplex virus (HSV) in pregnancy and the postpartum period can be a potentially devastating condition. Postpartum presentations may mimic bacterial sepsis and frequently present without mucocutaneous lesions, which can delay diagnosis and treatment. The purpose of this report is to highlight the diagnostic challenges of disseminated HSV presenting as postpartum sepsis and to emphasize the importance of early empiric antiviral therapy, especially at rural sites where rapid polymerase chain reaction (PCR) testing is not available. Methods We present the case of a 23 year old woman at 39 weeks’ gestation (gravida 4, para 0, abortus 3) who delivered a female infant via caesarean section. They were discharged from the hospital after 72 hours with no health concerns. Four days post-operatively, the patient re-presented and was admitted due to fever, exertional dyspnea, pleuritic chest pain, and generalized myalgia. Laboratory results and clinical observations were suggestive of septic shock, and intravenous (IV) antibiotics were started. Results Despite broad-spectrum antibiotic therapy, the patient remained unwell. On post-admission day 2, she disclosed a recent history of genital herpes infection several weeks prior to her caesarean section. IV acyclovir was started immediately, as our rural facility does not have access to on-site HSV PCR testing. Clinical improvement followed and vesicular lesions later developed near the caesarean site, supporting the diagnosis of disseminated HSV. The neonate remained asymptomatic through the clinical course. Conclusion This case illustrates the diagnostic uncertainty that may arise when disseminated HSV presents as postpartum sepsis. Clinicians should maintain a high index of suspicion for HSV infection in postpartum patients who fail to respond to antibiotic therapy, as early empiric antiviral treatment may significantly influence patient outcomes.