A unique case of IUD associated group A Streptococci pyogenic ascites

Group A Strep (GAS) infection associated with intrauterine devices (IUDs) is rare and only sporadically described following IUDs removal. We present a unique case of toxic shock syndrome presenting with pyogenic ascites following IUD removal in a 29 year old otherwise healthy woman. Upon admission, the patient primarily complained of abdominal pain and diarrhea and was found to have acute kidney injury. Despite empiric antibiotic therapy, her condition deteriorated, developing acute respiratory distress syndrome (ARDS), worsening renal failure, ascites, and a desquamating rash on her palms. All cultures obtained from blood, urine, stool, and peritoneal fluid were negative. However, 16S rRNA PCR testing of the peritoneal fluid confirmed the diagnosis of GAS. Source control and full recovery were achieved following an exploratory laparotomy with abdominal washouts in addition to antibiotics administration. This report adds to the limited literature on GAS infections associated with IUDs and demonstrates the need for heightened clinical suspicion and advanced diagnostic techniques in similar scenarios.