Peripartum cardiomyopathy with intrauterine fetal death complicated by multi-organ failure and a leukoerythroblastic blood picture: A case report

Abstract

Peripartum cardiomyopathy (PPCM) is a rare but life-threatening form of heart failure developing in the last 
month of pregnancy or within 5 months postpartum, in the absence of pre-existing cardiac disease. We report a 
22-year-old primigravida at 34.6 weeks who presented with progressive breathlessness and a severely impaired left 
ventricular ejection fraction of 15% on echocardiography, consistent with PPCM. Her course was further complicated 
by intrauterine fetal death, breech presentation, cardiogenic and septic shock, acute kidney injury, disseminated 
intravascular coagulation (DIC), and refractory metabolic acidosis. Peripheral blood smear examination, performed 
in the setting of a rising total leucocyte count, revealed a leukoerythroblastic picture with 33 nucleated red blood 
cells (nRBCs) per 100 white blood cells – a finding attributable to the convergence of profound hypoxia, DIC, multi
organ stress, and sepsis rather than primary bone marrow disease. This case highlights the catastrophic potential of 
unrecognized PPCM, the multifactorial etiology of reactive leukoerythroblastosis in critical obstetric illness, the 
imperative to correct the automated leucocyte count for nRBCs before interpretation, and the critical importance of 
culture-directed urgent antibiotic therapy.