Group A Streptococcus Septic Shock after Surgical Abortion: A Case Report and Review of the Literature

Received Apr 14, 2017; Revised Aug 4, 2017; Accepted Aug 8, 2017

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1. Introduction

Group A Streptococcus (GAS) infection is a leading cause of death from puerperal sepsis worldwide [1]. Prior to the antibiotic era, GAS infections were a major cause of peripartum morbidity and mortality [2]. Currently, approximately 246 cases of puerperal GAS infection are reported every year in the United States [3].

Although its incidence remains relatively rare, GAS infection is significant because of its potential to progress rapidly to septic shock, organ damage, and streptococcal toxic shock syndrome (TSS), which are associated with significant morbidity and mortality. Patients with invasive GAS infections who develop septic shock, streptococcal TSS, or necrotizing fasciitis have mortality rates of 45%, 38%, and 29%, respectively [3].

This is the first case report of invasive GAS infection after a surgical abortion. We present the clinical presentation, management, and treatment of a patient who presented with septic shock secondary to GAS infection after a first-trimester surgical termination of pregnancy.

2. Case Report

A 27-year-old gravida 6, para 3033 female was brought to the emergency room with a fever and severe lower abdominal pain that had begun 5 hours earlier. She had undergone a dilation and curettage at 6 weeks’ gestation 24 hours prior to presentation at a private outpatient family planning clinic unaffiliated to our institution. Her pain was sharp and diffuse and associated with nausea, vomiting, rigors, and dyspnea. She denied rashes, vaginal bleeding, or abnormal vaginal discharge.

Upon presentation to the emergency room, the patient’s vital signs were as follows: blood pressure of 130/69, heart rate of 131 beats per minute, respiratory rate of 18 breaths per minute, oxygen saturation on room air of 100%, and temperature of 38.0°C (100.4°F). Within the hour, she became hypotensive with a blood pressure of 77/54, heart rate of 111, respiratory rate...