A rare case of pregnancy complicated by connective tissue disease with pyogenic liver abscess leading to sepsis

Connective tissue disease (CTD) during pregnancy impairs innate and adaptive immune homeostasis and increases susceptibility to occult bacterial infection and subsequent sepsis. We report a 25-year-old G2P1 woman at 22 + 4 weeks of gestation presenting with recurrent intractable fever. Serological examinations showed elevated inflammatory indices, liver dysfunction, thrombocytopenia and positive autoimmune antibodies. Multimodal imaging revealed intrahepatic infectious lesions. Multidisciplinary consultation confirmed the coexistence of CTD, pyogenic liver abscess, sepsis and preeclampsia. The patient was treated with antibiotics, hepatoprotective agents and immune modulation. Considering severe fetal growth restriction and uncontrolled maternal infection, labor induction at 23 + 1 weeks gestation was performed. Hepatic puncture culture identified Streptococcus pneumoniae as the causative pathogen, and the patient achieved clinical recovery after targeted antimicrobial therapy. This case demonstrates the atypical manifestations and diagnostic difficulties of liver abscess in immunocompromised pregnant women. Early integrated serological-imaging screening and multidisciplinary collaboration are essential to optimize maternal and perinatal outcomes.