A Fatal Case of Streptococcal Toxic Shock Syndrome Developing in the Third Trimester of Pregnancy, China

Abstract Background Group A streptococcal (GAS) toxic shock syndrome (TSS) is a rare invasive disease, causing a high risk of maternal and fetal mortality during pregnancy. We report a fatal case of a female caused by GAS-TSS in the third trimester of pregnancy in Guangzhou, China. Case presentation: The patient is a 33-year-old female who presented at 37 weeks’ gestation with a history of three hours fever. She underwent an emergency cesarean section due to fetal bradycardia. The neonate survived after an aggressive anti-infection treatment. However, the patient’s condition deteriorated rapidly after the operation and the patient died of disseminated intravascular coagulation and septic shock within 24h after admission. She was finally diagnosed with GAS-TSS. The GAS strains were isolated from two bottles of blood cultures, which confirmed as Streptococcus pyogenes by 16S gene sequencing and identified as serotype M1 by molecular typing. Conclusions Dramatical clinical picture and laboratory characters of the pregnant woman presented here might help improve clinicians' awareness and recognition of Streptococcus pyogenes, which could be of great importance for the early diagnosis of GAS- TSS in pregnancy.