A Case of Postpartum Psychosis Associated with Typhoid and Urinary Tract Infection: A Complex Clinical Presentation
Abstract
Postpartum psychosis (PPP) is a rare but severe psychiatric disorder occurring shortly after childbirth. The present report describes a 37-year-old female who, three weeks after an uncomplicated vaginal delivery, developed acute psychosis coinciding with systemic infections - typhoid fever and Urinary Tract Infection (UTI). She initially presented with low mood, social withdrawal, disturbed sleep and auditory hallucinations. She was prescribed Sertraline 50 mg/day and Olanzapine 5 mg/day for 14 days, but she discontinued the medication due to poor insight. The day after her psychiatric consultation, she presented to the Emergency Department with high-grade fever, vomiting and decreased responsiveness. Blood culture grew Salmonella typhi and urine culture grew Escherichia coli. Initial antibiotic therapy with ceftriaxone and nitrofurantoin was started but later escalated to meropenem due to clinical deterioration. With combined psychiatric and antimicrobial management, the patient gradually improved. At discharge on day 21, she was psychiatrically stable, afebrile and laboratory parameters had normalised. At three-month follow-up, she remained in remission with continued adherence to medication. The present case underscores the diagnostic challenge of distinguishing PPP from infection-associated delirium and highlights the importance of multidisciplinary care and medication adherence.
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