Abstract
Invasive group A streptococcal infections, referred to as streptococcal toxic shock syndrome （STSS）, are rapidly progressive diseases that lead to septic shock and multi-organ failure. The mortality rate of STSS is as high as 30％. Additionally, severe sepsis can cause cardiomyopathy, which further increases mortality. Venoarterial extracorporeal membrane oxygenation （VA-ECMO） may offer rescue in such situations, but its indications and efficacy remain unclear. We present a case of a woman in her 40s with antithrombin （AT） deficiency who developed invasive group A streptococcal pyogenes infection. She exhibited necrotic fasciitis, septic shock, disseminated intravascular coagulation, and acute kidney injury. Despite ICU admission, administration of antibiotics, amputation of the infected right leg, use of vasopressors, mechanical ventilation, and renal replacement therapy, the infection spread to her right upper limb. Elevated serum lactate levels and physical findings indicated septic cardiomyopathy. We repeatedly assessed the need for VA-ECMO using transthoracic echocardiogram. However, complications such as antithrombin deficiency, which complicated anticoagulation management, and limitations in blood vessel access made VA-ECMO challenging to implement. The patient was transferred to an ECMO center where similar treatments were continued. She recovered without VA-ECMO and returned to the ICU after 8 days. She was subsequently transferred to a rehabilitation hospital on day 87. In patients with septic cardiomyopathy due to STSS and AT deficiency, frequent transthoracic echocardiographic evaluation are crucial for assessing the need for VA-ECMO, which carries a high risk of complications. This approach helps in managing complex cases and ensuring appropriate patient management.
