2020 Volume 27 Issue 5 Pages 403-407
A 40-year-old pregnant woman presented to our hospital with sudden onset of high-grade fever and severe abdominal pain. Her clinical course suggested haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome or placental abruption, and she underwent an emergency cesarean section. The patient’s recent medical history along with intraoperative findings suggested progressive perinatal group A streptococcal toxic shock syndrome (STSS). Empiric antimicrobial therapy, using ampicillin and clindamycin, was initiated while the surgery was still under way. She developed hemolytic anemia, acute kidney injury (AKI), and signs of concomitant thrombotic microangiopathy (TMA). Plasma exchange (PE) was initiated in the ICU. She was transferred to the ward on hospital day 7, and was discharged without any complications on hospital day 25. Immediate commencement of empiric antimicrobial therapy and intensive care management, including PE and renal replacement therapy, can help in recovering from severe STSS-induced illness.
