Abstract
Streptococcal toxic shock syndrome (STSS) is a life-threatening illness mainly caused by invasive group A Streptococcus (GAS) infection. Herein, we report a case of a postmenopausal woman who developed STSS from an ascending vaginal GAS infection after cytocervical sampling. The patient complained of vaginal discharge, for which she underwent gynecological examination with vaginal sampling. The following day, there was onset of diarrhea and vomiting. After 7 days, she was admitted to our hospital with septic shock. Necrotizing enterocolitis was suspected and surgical intervention was performed; however, the patient was diagnosed with primary peritonitis and antibiotics were initiated. On day 2, GAS was suspected by blood cultures, and antibiotics were changed in consideration of STSS. On day 4, GAS was confirmed in blood, ascitic fluid, and vaginal swab specimens, and STSS caused by an ascending vaginal GAS infection was diagnosed. This case report indicates that STSS could occur following cytocervical sampling for vaginal discharge. If a woman has unexplained septic shock, especially with gastroenteritis symptoms, STSS should be considered as a differential diagnosis.
Highlights
Streptococcal toxic shock syndrome (STSS) is a critical illness caused by group A Streptococcus (GAS) and can rapidly lead to fatal multiorgan failure [1]
The patient in this study initially presented with a chief complaint of abnormal vaginal discharge and vulvar itching and was later found to have GAS vaginitis
Several cases of STSS caused by an ascending vaginal GAS infection have been reported in women who have lactational amenorrhea or are postmenopausal [16, 17]
Summary
Streptococcal toxic shock syndrome (STSS) is a critical illness caused by group A Streptococcus (GAS) and can rapidly lead to fatal multiorgan failure [1]. GAS colonizes the vagina, especially in women with lactational amenorrhea, menopausal women, and prepubescent girls [7,8,9], and vaginitis caused by GAS can progress to STSS [10]. Few studies reported that STSS caused by an ascending vaginal GAS infection may develop after interventional procedures, such as endometrial biopsy, intrauterine contraceptive device insertion, or hysteroscopy [11,12,13,14,15]. Cytocervical sampling has not yet been recognized as a predisposing cause of STSS. We report a case of GAS-induced STSS after cytocervical sampling
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