Abstract
Background: Severe Group A Streptococcus (GAS) infections began to be reported in the 1980s. The most common portals of entry for GAS infections are the pharynx and skin, but in many cases, the portal of entry cannot be identified. We report here 2 cases with severe GAS infection that developed after the harvesting procedure for endometrial cytology.
Case 1: A 46-year-old, gravida 1, para 1 woman presented with yellowish discharge and pruritus vulva. She underwent harvesting of endometrial cytology, and her vaginal discharge was subjected to bacterial culture. The next day, severe stomachache developed. Two days after the initial presentation, she was admitted to our emergency department due to high fever and shock. As pelvic inflammatory disease (PID) associated with septic shock was suggested, we first treated her with empiric antibiotics, intravenous dopamine, and fluid resuscitation. Then, GAS was isolated from not only the vaginal culture, but also the blood; a diagnosis of invasive GAS infection was established. The patient was next treated with benzylpenicillin, intravenous immunoglobulin, and direct hemoperfusion with polymyxin B-immobilized fiber. She finally underwent laparoscopic surgery with intraperitoneal drainage.
Case 2: A 52-year-old, gravida 2, para 2 woman underwent a complete physical examination in our hospital, including harvesting for endometrial cytology. She vomited, felt a chill, and exhibited shivering on the exami nation day. The next day, she was admitted to our emergency department due to high fever and shock. GAS was isolated from both vagina and blood cultures, establishing the diagnosis of severe invasive GAS infection. She was treated with antibiotics, intravenous dopamine and noradrenaline, and rapid fluid resuscitation, resulting in improvement of her condition without further treatments.
Conclusion: We experienced 2 cases of invasive GAS infection that developed after the harvesting procedure for endometrial cytology. We often perform cytological analysis of the endometrium, but have seldom experienced invasive GAS infection. Physicians have to be aware that invasive GAS infection can occur after routine intrauterine procedures such as harvesting for cytology of the endometrium.
