Maternal Sepsis: The Diagnostic Challenge in a Comorbid Patient in Mexico

Maternal sepsis is a complication that can be difficult to diagnose in the early stages because symptoms can be vague or attributed to other conditions. We present the case of a 38-year-old woman, in her third pregnancy with a diagnosis of uncontrolled gestational diabetes, who developed urinary origin sepsis in the second trimester of pregnancy. The patient was initially admitted with a clinical presentation interpreted as a urinary tract infection. However, her condition quickly deteriorated with sudden dyspnea, hypotension, and tachycardia. She was approached as a probable aortic dissection and transferred to a tertiary care facility for definitive treatment. Upon arrival at the reference center, the diagnosis of urinary focus sepsis was established, with imaging studies showing right pyelocaliceal dilatation and inflammatory process. The appropriate antibiotic treatment was delayed due to the lack of an early diagnosis, leading to clinical deterioration that necessitated urgent surgery. The therapeutic approach included broad-spectrum antibiotics and the placement of a right JJ catheter with drainage of purulent material, followed by intensive management. This case highlights the diagnostic challenge posed by maternal sepsis and underscores the critical role of early recognition through scoring systems, emphasizing the need for increased clinical suspicion and immediate attention.