Unexpected sepsis due to Group A beta haemolytic Streptococcus following total thyroidectomy

Thyroidectomy is a clean surgery, with the presentation of postoperative infections being uncommon and an exceedingly rare incidence of postoperative sepsis.A female patient in her early 80s became acutely unwell following total thyroidectomy within the immediate postoperative period, with features suggestive of sepsis. She developed new-onset atrial fibrillation (AF), and her care was escalated to the intensive treatment unit (ITU) on the same day postoperatively. While in the ITU, she deteriorated with multiorgan failure (MOF). There was no evidence of a surgical site infection (SSI).Beta haemolytic lancefield Group A Streptococcus (GAS) was isolated from positive blood cultures, confirming the diagnosis of streptococcal toxic shock syndrome (TSS). She was treated with targeted antibiotics and intravenous immunoglobulin (IG) and received supportive care for MOF.In our case, sepsis developed in the immediate postoperative period of total thyroidectomy. A high index of suspicion and prompt treatment are required to minimise the risks of morbidity and mortality.