Septic Miscarriage With Severe Sepsis Due to Nakaseomyces glabratus Fungemia in a Second‐Trimester IVF Pregnancy: A Case Report

Miscarriage is recognized as a leading cause of maternal morbidity. It can result in sepsis and septic shock, which is a life‐threatening condition requiring urgent intervention. While bacterial infections are the most common culprits in septic miscarriages, Nakaseomyces glabrata (formerly Candida glabrata ) has emerged as an increasingly recognized cause of severe infections in immunocompromised hosts and those undergoing in vitro fertilization (IVF). A 40‐year‐old woman (G3P1) presented at 19 weeks and 3 days of gestation following a successful IVF cycle. Immunomodulation via Intralipid was given as an adjunctive therapy to IVF. Intralipid is a sterile intravenous lipid emulsion composed of soybean oil‐derived polyunsaturated fatty acids, egg yolk phospholipids, and glycerol. On presentation, the patient reported fever, vaginal bleeding, and the passage of amniotic fluid. Intravenous cefuroxime plus metronidazole were initiated. Expectant management was initially deemed appropriate. However, over the following 12 h, her clinical status deteriorated despite aggressive fluid resuscitation and the addition of gentamicin. She received 600 mg of mifepristone to reduce the likelihood of uterine rupture in view of her previously scarred uterus. Nonetheless, her hypotension persisted, necessitating the start of oxytocin. She delivered within the next 2 h. Blood cultures grew N . glabrata . With antifungal therapy, the patient’s condition steadily improved, and she was discharged from care in a stable state on Day 15. This report describes N. glabrata fungemia in a second‐trimester IVF pregnancy and its successful management with caspofungin. It underscores the importance of considering fungal infections as potential causes of septic miscarriage, particularly in high‐risk pregnancies and immunocompromised states.