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Post–Loop Electrosurgical Excision Procedure Sepsis in a Human Immunodeficiency Virus–Infected Woman

Szymanski, Linda M. MD, PhD1; Little, Richard MD2; Matthews, Douglas C. MS, CRNP2; Stratton, Pamela MD1

doi: 10.1097/01.AOG.0000171107.88468.29
Case Report

BACKGROUND: Squamous intraepithelial lesions are more prevalent in women infected with the human immunodeficiency virus (HIV) compared with immunocompetent women. Loop electrosurgical excision procedure (LEEP) is commonly used to treat squamous intraepithelial lesions because it may be performed as an outpatient procedure with minimal blood loss and a low complication rate.

CASE: We report a major infectious post-LEEP complication in an HIV-infected female who had an uneventful LEEP in which a cellulose hemostatic agent was used. Despite the severity of the infection, she was successfully treated with a minor surgical procedure along with broad antibiotic coverage.

CONCLUSION: Although a cellulose hemostatic agent contaminated with perineal secretions may have served as a nidus for infection, use of perioperative antibiotics or cervical cleansing should be considered to prevent sepsis in immunocompromised hosts.

Sepsis occurred in an HIV-infected woman after an uneventful loop electrosurgical excision procedure and was successfully treated with broad-spectrum antibiotics and minor surgery.

From the 1Pediatric and Reproductive Endocrinology Branch, National Institutes of Child Health and Human Development, National Institutes of Health; and 2AIDS Malignancy Clinical Research Section, Medical Oncology Clinical Research Unit, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

Corresponding author: Pamela Stratton, MD, Chief, Gynecology Consult Service, Pediatric and Reproductive Endocrinology Branch, National Institutes of Child Health and Human Development, National Institutes of Health, Bldg. 10, CRC, Room 1–3140, 10 Center Drive MSC 1109, Bethesda, MD 20892–1109; e-mail: strattop@cc1.nichd.nih.gov.

© 2006 The American College of Obstetricians and Gynecologists