Case Report: Pediatric group A streptococcal toxic shock syndrome complicated by acute necrotizing tracheobronchitis requiring veno-venous extracorporeal membrane oxygenation
- 1Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China
Abstract
Group A streptococcal toxic shock syndrome (STSS) in children is uncommon and can progress rapidly to multi-organ failure. Acute necrotizing tracheobronchitis (NTB) is a rare airway complication of severe infection and has seldom been reported during extracorporeal support. We describe a previously healthy 7-year-old girl admitted with 6 days of fever and 3 h of chest tightness and dyspnea. She developed septic shock, severe pneumonia, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), acute kidney injury, and multi-organ dysfunction. Blood and sputum cultures were negative at 48 h. Metagenomic next-generation sequencing (mNGS) of blood and bronchoalveolar lavage fluid identified Streptococcus pyogenes. Serial fiberoptic bronchoscopy was used for airway clearance and extubation assessment. Procedure records described progression from mucosal congestion to erosive necrosis with pseudomembrane-like plaques, followed by healing included broad-spectrum antimicrobials, corticosteroids, intravenous immunoglobulin (IVIG), tocilizumab, hemoperfusion, continuous renal replacement therapy (CRRT), and veno-venous extracorporeal membrane oxygenation (ECMO) from hospital days 2 to 9. Lung ultrasound during ECMO showed confluent B-lines with regional A-lines. Ultrasound images were acquired on day 3; a day-4 progress note recorded a left ventricular ejection fraction (LVEF) of 62% and mild tricuspid regurgitation. In the setting of markedly elevated troponin, these findings favored sepsis-associated myocardial injury over fulminant myocarditis. ECMO was discontinued on day 9, CRRT on day 10, and the patient was extubated on day 13 after bronchoscopy showed improved airway necrosis. She was discharged on hospital day 28, 27 days after admission. At follow-up, an intratracheal granulation-tissue lesion was excised endoscopically, and the family reported preserved neurocognitive function. Together, these findings show that NTB can complicate pediatric group A streptococcal STSS and that serial bronchoscopy may help guide ventilator and ECMO weaning; as one case without a comparison group, it does not establish which treatments were responsible for recovery.
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BibTeX
@article{deng2026case,
title = {{Case Report: Pediatric group A streptococcal toxic shock syndrome complicated by acute necrotizing tracheobronchitis requiring veno-venous extracorporeal membrane oxygenation}},
author = {Hongsheng Deng and Kun Chen and Ke Chen},
journal = {Frontiers in Pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1900220},
url = {https://doi.org/10.3389/fped.2026.1900220},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Pediatric group A streptococcal toxic shock syndrome complicated by acute necrotizing tracheobronchitis requiring veno-venous extracorporeal membrane oxygenation
AU - Hongsheng Deng
AU - Kun Chen
AU - Ke Chen
PY - 2026
DA - 2026/10/21
JO - Frontiers in Pediatrics
DO - 10.3389/fped.2026.1900220
UR - https://doi.org/10.3389/fped.2026.1900220
AB - Group A streptococcal toxic shock syndrome (STSS) in children is uncommon and can progress rapidly to multi-organ failure. Acute necrotizing tracheobronchitis (NTB) is a rare airway complication of severe infection and has seldom been reported during extracorporeal support. We describe a previously healthy 7-year-old girl admitted with 6 days of fever and 3 h of chest tightness and dyspnea. She developed septic shock, severe pneumonia, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), acute kidney injury, and multi-organ dysfunction. Blood and sputum cultures were negative at 48 h. Metagenomic next-generation sequencing (mNGS) of blood and bronchoalveolar lavage fluid identified Streptococcus pyogenes. Serial fiberoptic bronchoscopy was used for airway clearance and extubation assessment. Procedure records described progression from mucosal congestion to erosive necrosis with pseudomembrane-like plaques, followed by healing included broad-spectrum antimicrobials, corticosteroids, intravenous immunoglobulin (IVIG), tocilizumab, hemoperfusion, continuous renal replacement therapy (CRRT), and veno-venous extracorporeal membrane oxygenation (ECMO) from hospital days 2 to 9. Lung ultrasound during ECMO showed confluent B-lines with regional A-lines. Ultrasound images were acquired on day 3; a day-4 progress note recorded a left ventricular ejection fraction (LVEF) of 62% and mild tricuspid regurgitation. In the setting of markedly elevated troponin, these findings favored sepsis-associated myocardial injury over fulminant myocarditis. ECMO was discontinued on day 9, CRRT on day 10, and the patient was extubated on day 13 after bronchoscopy showed improved airway necrosis. She was discharged on hospital day 28, 27 days after admission. At follow-up, an intratracheal granulation-tissue lesion was excised endoscopically, and the family reported preserved neurocognitive function. Together, these findings show that NTB can complicate pediatric group A streptococcal STSS and that serial bronchoscopy may help guide ventilator and ECMO weaning; as one case without a comparison group, it does not establish which treatments were responsible for recovery.
SN - 2296-2360
ER -