Abstract
Group A streptococcal toxic shock syndrome progresses rapidly to septic shock, diffuse intravascular
coagulation, and multiorgan failure. The perinatal type is particularly fulminant and causes a high
rate of fetal and maternal death. There are very few cases in which the mother survives when the fetus has already died upon arrival at the hospital. Herein, we present a case of streptococcal toxic shock syndrome with intrauterine fetal death. A 41-year-old female visited our hospital at 37 weeks of gestation with fever, abdominal pain, diarrhea, and decreased fetal movement. Intrauterine fetal death was confirmed, and the baby was delivered 2.5 hours after arrival at the hospital. Based on the disease course, fulminant group A streptococcal infection was suspected and high-dose antibiotics were initiated, followed by intensive treatment in cooperation with physicians. The patient was discharged without complications. When a pregnant female presents with fever, labor-like abdominal pain, or an abnormal fetal heart rate, it is important to be aware of the possibility of fulminant group A streptococcal infection and provide immediate therapeutic intervention in collaboration with other relevant departments, while considering the quick sepsis-related organ failure score.〔Adv Obstet Gynecol, 78（1）, 45-52, 2026（R8．2）〕
