[Pneumonia and Streptococcal Toxic Shock Syndrome Due to Group A Streptococci: A Case Report]

A 71-year-old woman who was undergoing immunosuppressive therapy presented with a 7-day history of productive cough and 2-day history of fever. She was diagnosed with severe pneumonia and septic shock. Meropenem, azithromycin, large amounts of fluids, and noradrenaline were administered, and high-flow nasal cannula oxygen therapy was provided. The gross appearance of the aspirated sputum was ginger-like, and the gram-positive cocci in chains were identified as group A beta-hemolytic streptococci (GAS), Streptococcus pyogenes. The blood sample culture test revealed negative results. Based on Stevens' criteria, the patient was finally diagnosed as having streptococcal toxic shock syndrome (STSS). Antibiotics were switched to ampicillin/sulbactam and clindamycin as an antitoxin treatment, and the patient was discharged on day 33. Serotypes of GAS were T1, M1, and emm1. Superantigens spe A, spe B, and spe F were present, and spe C was absent. These observations were compatible with the clinical features of hypotension. GAS is an uncommon cause of community-acquired pneumonia, which when potentially complicated with STSS can lead to a high mortality rate, and the rapid progression is particularly a striking feature. We should be aware that GAS can cause pneumonia, and antitoxin treatment can play a key role in STSS management.