{
  "abstract": "Streptococcal toxic shock syndrome caused by Streptococcus pyogenes can rapidly progress to refractory shock and multiorgan failure. Pneumonia is a rare manifestation of invasive group A streptococcal infections. A previously healthy 41-year-old woman developed palpitations 4 days after testing positive for severe acute respiratory syndrome coronavirus 2 and was transferred with severe pneumonia, profound shock, and hypoxemic respiratory failure. Upon arrival, the PaO2/FiO2 ratio was 71, lactate concentration was 4.63 mmol/L, and Sequential Organ Failure Assessment score was 11. Blood cultures were obtained before antibiotic administration. Empirical piperacillin-tazobactam, teicoplanin, and levofloxacin were started approximately 1 h after arrival, along with mechanical ventilation, vasopressors, hydrocortisone, and subsequent continuous renal replacement therapy. Despite intensive treatment, shock and metabolic acidosis progressed, and the patient died approximately 15 h after arrival. All four blood-culture bottles flagged positive within 8.8–9.6 h, and Streptococcus pyogenes was identified from blood and an endotracheal aspirate after the patient died. The isolate was emm3 and carried speA and speB. Autopsy revealed necrotizing suppurative pneumonia with abscess formation and numerous gram-positive cocci with no alternative infectious focus. Fulminant invasive bacterial infection should be considered despite recent COVID-19 when pneumonia is accompanied by rapidly progressive shock and coagulopathy.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan",
    "Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Nobuyuki Hattori"
    },
    {
      "affs": [
        0
      ],
      "name": "Seiya Kanou"
    },
    {
      "affs": [
        0
      ],
      "name": "Masayuki Iwashita"
    },
    {
      "affs": [
        0
      ],
      "name": "Taichiro Tsunoyama"
    },
    {
      "affs": [
        1
      ],
      "name": "Ayumi Tanaka"
    },
    {
      "affs": [
        0
      ],
      "name": "Takashi Suzuki"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ejp0sms0vj1kh.bib",
  "cited_by": 0,
  "doi": "10.1016/j.idcr.2026.e02822",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13734853/",
  "id": "ejp0sms0vj1kh",
  "issns": [
    "2214-2509"
  ],
  "landing_url": "https://doi.org/10.1016/j.idcr.2026.e02822",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2725|Streptococcal Infections and Treatments"
    ]
  ],
  "openalex": "W7223203586",
  "pdf_url": null,
  "pmcid": "PMC13734853",
  "pmid": "42990912",
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/ejp0sms0vj1kh.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:20:40Z",
      "native_id": "PMC13734853",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.idcr.2026.e02822"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2725|Streptococcal Infections and Treatments",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Fulminant streptococcal toxic shock syndrome due to autopsy-confirmed emm3 Streptococcus pyogenes necrotizing pneumonia in a patient with COVID-19",
  "title_text": "Fulminant streptococcal toxic shock syndrome due to autopsy-confirmed emm3 Streptococcus pyogenes necrotizing pneumonia in a patient with COVID-19",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:20:40Z",
  "url": "https://research.draconitic.com/paper/ejp0sms0vj1kh",
  "venue": "IDCases",
  "versions": []
}