Fulminant streptococcal toxic shock syndrome due to autopsy-confirmed emm3 Streptococcus pyogenes necrotizing pneumonia in a patient with COVID-19
- 1Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
- 2Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan
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.
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BibTeX
@article{hattori2026fulminant,
title = {{Fulminant streptococcal toxic shock syndrome due to autopsy-confirmed emm3 Streptococcus pyogenes necrotizing pneumonia in a patient with COVID-19}},
author = {Nobuyuki Hattori and Seiya Kanou and Masayuki Iwashita and Taichiro Tsunoyama and Ayumi Tanaka and Takashi Suzuki},
journal = {IDCases},
year = {2026},
month = oct,
doi = {10.1016/j.idcr.2026.e02822},
url = {https://doi.org/10.1016/j.idcr.2026.e02822},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Fulminant streptococcal toxic shock syndrome due to autopsy-confirmed emm3 Streptococcus pyogenes necrotizing pneumonia in a patient with COVID-19
AU - Nobuyuki Hattori
AU - Seiya Kanou
AU - Masayuki Iwashita
AU - Taichiro Tsunoyama
AU - Ayumi Tanaka
AU - Takashi Suzuki
PY - 2026
DA - 2026/10/23
JO - IDCases
DO - 10.1016/j.idcr.2026.e02822
UR - https://doi.org/10.1016/j.idcr.2026.e02822
AB - 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.
SN - 2214-2509
ER -