[A delayed threat: S. aureus sepsis 4 years post-IUD insertion in a healthy young woman]

Intrauterine devices (IUDs) are highly effective long-acting reversible contraceptives with an established safety profile. Infectious complications are rare and usually occur shortly after insertion, typically involving polymicrobial pathogens. Staphylococcus aureus is an uncommon pathogen in this context, but its biofilm-forming ability may contribute to delayed and severe presentations.

A healthy 25-year-old primiparous woman developed septic shock four years after the insertion of a levonorgestrel-releasing intrauterine system (Mirena®). She was admitted to the intensive care unit with fever, abdominal pain, and hemodynamic instability requiring vasopressor support. The IUD was removed, and cultures grew methicillin-susceptible Staphylococcus aureus (MSSA), while blood cultures were negative. She subsequently improved following device removal, targeted intravenous antibiotics, and supportive intensive care. Notably, nasal carriage was negative in the patient but positive in her partner, suggesting a possible source of colonization.

This case illustrates a rare but life-threatening complication of IUD use: septic shock secondary to S. aureus biofilm infection, manifesting years after device insertion. Clinicians should maintain a high index of suspicion for device-related infection in women with unexplained sepsis. Prompt device removal, targeted antimicrobial therapy, and multidisciplinary ICU care are critical for optimal outcomes. The possible contribution of partner colonization to the pathogenesis of such infections warrants further investigation.