Misoprostol induced Hyperpyrexia mimicking Sepsis: A Case Report

Abstract

Background: Misoprostol, a prostaglandin E1 analogue widely used for cervical ripening and labor induction, is known to cause transient pyrexia and shivering. However, high-gradehyperpyrexia mimicking sepsis is uncommon and may lead to unnecessary investigations and antibiotic exposure. Awareness of this adverse effect is essential to avoid misdiagnosis andovertreatment.
Case Presentation: A 28-year-old primigravida at 41+2 weeks of gestation underwent induction of labor for post-datism. Following an uneventful antenatal course, she received 25 μgintravaginal misoprostol. A second identical dose was administered after four hours. Ninety minutes later, she developed sudden high-grade fever (104.5°F), chills, rigors, tachycardia (132bpm), and mild tachypnea. Blood pressure remained stable (110/70 mmHg) and fetal heart rate was reassuring (150 bpm). There were no signs of uterine tenderness or foul-smellingdischarge. In view of suspected sepsis, complete blood counts, urine analysis, and blood and urine cultures were obtained and broad-spectrum intravenous antibiotics were initiated. The feverresolved spontaneously within seven hours without hemodynamic compromise. Labor progressed normally and she delivered a healthy neonate vaginally. All cultures remained negative at 48hours; antibiotics were discontinued and the postpartum period was uneventful.
Conclusion: Misoprostol-induced hyperpyrexia is a rare but benign adverse effect that may closely resemble sepsis. Clinicians should recognize this presentation, particularly in the absenceof other infectious features, to prevent unwarranted interventions. Vigilance, timely assessment, and expectant observation can minimize maternal morbidity and avoid unnecessary antibioticuse while ensuring maternal-fetal safety.