Pyogenic flexor tenosynovitis complicated by necrotizing soft tissue infection in postpartum: A case report

Pregnancy and the immediate postpartum are periods of immune reconstitution inflammatory syndrome (IRIS), exposing patients to an increased risk of severe infections. Among these, necrotizing soft tissue infection (NSTI) is a rare but serious, life- and function-threatening condition.

We report the case of a 31-year-old patient three weeks postpartum, admitted for acute right hand pain with septic signs. The initial clinical picture, typical of a pyogenic flexor tenosynovitis of the ring finger, rapidly evolved into NSTI of the palm. Despite urgent medical and surgical management including two successive surgical interventions, broad spectrum antibiotic therapy and intensive care follow-up, the evolution was marked by necrosis of multiple fingers, necessitating digital amputations.

This case illustrates the potential severity of bacterial infection of the hand in a postpartum context, favored by IRIS. It also highlights the importance of early surgical management, even in cases of minimal cutaneous entry point, to limit major functional complications.

In the context of pregnancy or postpartum, any soft-tissue infection should alert to the risk of fulminant evolution. Early, multidisciplinary medical and surgical management is essential to limit morbidity, mortality and preserve function.