Many faces of sepsis: Hurvitz syndrome in obstetric practice
Bezhenar V.F., Arakelyan B.V., Vanchikova O.V., Nesterov I.M., Rozhdestvenskaya O.V., Afanasiev A.A., Tkachev D.N., Prudnikov A.V., Tikhonova Yu.A., Perinykh A.A.
Rationale. Septic complications account for a significant number of adverse outcomes during pregnancy, childbirth, and the postpartum period. Despite improvements in diagnostic methods and treatment approaches, the incidence of fatal postpartum sepsis is increasing worldwide.
Case report. The article describes a clinical case of sepsis in a patient with antenatal fetal death, complicated by secondary thrombotic microangiopathy, acute kidney injury with the development of interstitial tubular necrosis, Hurwitz syndrome, bilateral pneumonia and other signs of the underlying pathological process.
Patient D., 37 years old, was delivered by cesarean section (second term delivery, antenatal death of the fetus outside a medical facility). Given the diagnosed panmetritis, the scope of the operation was expanded to a hysterectomy with fallopian tubes. In the postoperative period following the onset of sepsis, the patient developed multiple-organ failure (renal, respiratory, hepatic, cardiac, adrenal, and protein-energy wasting). A distinctive feature of the case course was Hurwitz syndrome. Signs of thrombotic microangiopathy, including microangiopathic anemia (elevated lactate dehydrogenase levels, decreased haptoglobin levels) and thrombocytopenia were also verified. The patient underwent massive de-escalating antibacterial therapy, plasma exchange, blood transfusions, plasma transfusions, acute hemodialysis with ultrafiltration (citrate anticoagulation), cardiotropic, gastroprotective, immunological, antiviral (ganciclovir), and antifungal therapy. Gut microbiota transplantation was performed twice to correct intestinal dysbiosis and antibiotic-associated diarrhea.
Conclusion. This case study concerns a near miss event caused by severe abdominal sepsis, with the development of an extremely rare complication – Hurwitz syndrome. The uniqueness and value of this clinical case implies the presence of the data on a possible new manifestation of multiple-organ failure syndrome in sepsis-associated patients in the postpartum period.
Authors’ contributions. Bezhenar V.F., Arakelyan B.V., Rozhdestvenskaya O.V. – study concept and design; Rozhdestvenskaya O.V., Afanasiev A.A., Tkachev D.N., Prudnikov A.V., Perinykh A.A., Tikhonova Yu.A. – data collection and processing, illustrations supply; Rozhdestvenskaya O.V. – review of related publications; Arakelyan B.V., Rozhdestvenskaya O.V. – manuscript writing; Bezhenar V.F., Arakelyan B.V., Vanchikova O.V., Nesterov I.M. – manuscript editing.
Conflicts of interest. The authors declare no conflicts of interest.
Funding. The research received no external funding.
Generative Artificial Intelligence. No generative artificial intelligence technologies were used while describing the case study.
Patient Consent for Publication. The patient provided a written informed consent for the publication of her data and associated images in anonymized form.
For citation Bezhenar V.F., Arakelyan B.V., Vanchikova O.V., Nesterov I.M., Rozhdestvenskaya O.V.,
Afanasiev A.A., Tkachev D.N., Prudnikov A.V., Tikhonova Yu.A., Perinykh A.A.
Many faces of sepsis: Hurvitz syndrome in obstetric practice.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (9): 182-190 (in Russian)
https://dx.doi.org/10.18565/aig.2025.327
Keywords
obstetric sepsis
Hurwitz syndrome
atypical hemolytic uremic syndrome
thrombotic microangiopathy
antenatal fetal death
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Received 12.11.2025
Accepted 07.02.2025
About the Authors
Vitaly F. Bezhenar, Dr. Med. Sci., Professor, Head of the Department of Obstetrics, Gynecology and Reproductology, Head of the Clinic of Obstetrics and Gynecology,Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8; Main Supernumerary Specialist Obstetrician-Gynecologist of the Health Committee of St. Petersburg, bez-vitaly@yandex.ru, https://orcid.org/0000-0002-7807-4929
Buzand V. Arakelyan, Dr. Med. Sci., Professor at the Department of Obstetrics, Gynecology and Reproductology, Deputy Head of the Clinic of Obstetrics and Gynecology, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, byuzand@mail.ru,
https://orcid.org/0000-0002-2868-7997
Olga V. Vanchikova, Deputy Head of the Clinic of Obstetrics and Gynecology, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia,
197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, olgavanchikova@list.ru
Igor M. Nesterov, PhD, Associate Professor, Department of Obstetrics, Gynecology and Reproductology, Pavlov First Saint Petersburg State Medical University,
Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, ignester@yandex.ru, https://orcid.org/0000-0002-7558-7657
Olga V. Rozhdestvenskaya, PhD, Assistant, Department of Obstetrics, Gynecology and Reproductology, Pavlov First Saint Petersburg State Medical University,
Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, olgamish@inbox.ru, https://orcid.org/0000-0003-2280-9196
Alexey A. Afanasiev, Head of the Department of ICU No. 1, Research Institute of Surgery and Emergency Medicine, Assistant at the Department of Anesthesiology and Resuscitation, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, alex-txf@mail.ru, https://orcid.org/0000-0002-2933-5686
Denis N. Tkachev, anesthesiologist-resuscitator of ICU No. 1, Research Institute of Surgery and Emergency Medicine, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, vambambigalo@yandex.ru
Alexander V. Prudnikov, Endoscopic Department No. 1, Research Institute of Surgery and Emergency Medicine, Pavlov First Saint Petersburg State Medical University,
Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8.
Yuliana A. Tikhonova, Associate Professor at the Department of Pathological Anatomy with Pathological Department, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, jat1@mail.ru, https://orcid.org/0000-0002-1985-0465
Alexandra A. Perinykh, PhD, Assistant at the Department of Propaedeutics of Internal Diseases with the Clinic named after Academician M.D. Tushinsky, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, perya@list.ru
Corresponding author: Olga V. Rozhdestvenskaya, olgamish@inbox.ru
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