{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:40:03Z","timestamp":1756280403974,"version":"3.44.0"},"reference-count":21,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,28]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>In the puerperal phase, streptococcal toxic shock syndrome is a relatively uncommon occurrence. However, there has been a rise in the prevalence of more aggressive strains of Group A Streptococcus (GAS), leading to significant maternal morbidity and mortality. In this report, we present a case of a postpartum patient who developed streptococcal toxic shock syndrome with substantial inflammation shortly after delivery. The patient presented on the second postpartum day with hypotension, high fever, hypogastric tenderness and anaemia. After timely workup and appropriate antibiotic therapy, the patient fully recovered. Culture studies confirmed Gram-positive septicaemia with the presence of <jats:italic>Streptococcus pyogenes<\/jats:italic> in both the patient\u2019s blood and a previously inserted intrauterine device (IUD). This case underscores the importance of maintaining a high index of suspicion for GAS as the cause of puerperal infections despite its rarity. This results in prompt administration of antibiotics and source control, preventing consequences and avoiding mortality.<\/jats:p>","DOI":"10.1136\/bcr-2023-258863","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T12:46:53Z","timestamp":1739278013000},"page":"e258863","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Streptococcal toxic shock syndrome in the immediate postpartum period"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0425-6276","authenticated-orcid":false,"given":"Dana Lee Macasaet","family":"Benitez","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology, University of the Philippines Manila College of Medicine, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia Ann Africa","family":"Factor","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, University of the Philippines Manila College of Medicine, Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"2025082700010910000_18.2.e258863.1","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/aogs.14500","article-title":"Outcomes and management of pregnancy and puerperal group A streptococcal infections: A systematic review","volume":"102","author":"Harris","year":"2023","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025082700010910000_18.2.e258863.2","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1097\/AOG.0000000000004471","article-title":"Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis","volume":"138","author":"Shields","year":"2021","journal-title":"Obstetrics & Gynecology"},{"key":"2025082700010910000_18.2.e258863.3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.nwh.2019.11.006","article-title":"Group A Streptococcal Infection During Pregnancy and the Postpartum Period","volume":"24","author":"Phillips","year":"2020","journal-title":"Nurs Womens Health"},{"key":"2025082700010910000_18.2.e258863.4","first-page":"721","article-title":"Streptococcal screening in obstetrics","volume":"98","author":"Mead","year":"2001","journal-title":"Obstetrics & Gynecology"},{"key":"2025082700010910000_18.2.e258863.5","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/S1526-9523(03)00284-8","article-title":"Group A Streptococcus and Streptococcal Toxic Shock Syndrome: A Postpartum Case Report","volume":"48","author":"Golden","year":"2003","journal-title":"J Midwife Womens Health"},{"key":"2025082700010910000_18.2.e258863.6","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir325"},{"key":"2025082700010910000_18.2.e258863.7","doi-asserted-by":"publisher","DOI":"10.3109\/13625180903149159"},{"key":"2025082700010910000_18.2.e258863.8","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000175"},{"key":"2025082700010910000_18.2.e258863.9","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S1068-607X(00)00027-5","article-title":"Toxic shock syndrome","volume":"7","author":"Reiss","year":"2000","journal-title":"Prim Care Update Ob Gyns"},{"key":"2025082700010910000_18.2.e258863.10","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-94-2-149"},{"key":"2025082700010910000_18.2.e258863.11","doi-asserted-by":"crossref","DOI":"10.1186\/s13613-018-0438-y","article-title":"Streptococcal toxic shock syndrome in the intensive care unit","volume":"8","author":"Schmitz","year":"2018","journal-title":"Ann Intensive Care"},{"key":"2025082700010910000_18.2.e258863.12","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1080\/00325481.2020.1760031","article-title":"Invasive Group A streptococcal postpartum endometritis associated with multi-organ infarctions: an uncommon case presentation and literature review","volume":"132","author":"Riad","year":"2020","journal-title":"Postgrad Med"},{"key":"2025082700010910000_18.2.e258863.13","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit282"},{"key":"2025082700010910000_18.2.e258863.14","unstructured":"Chen K . Postpartum endometritis. UpToDate; 2023. Available: https:\/\/www.uptodate.com\/contents\/postpartum-endometritis?search=postpartum%20endometritis [Accessed 22 Apr 2023]."},{"key":"2025082700010910000_18.2.e258863.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2009.05.030"},{"key":"2025082700010910000_18.2.e258863.16","doi-asserted-by":"crossref","first-page":"3481","DOI":"10.2169\/internalmedicine.6290-20","article-title":"Streptococcal Toxic Shock Syndrome Induced by Group A Streptococcus with the emm28 Genotype That Developed after a Uterine Cancer Test","volume":"60","author":"Yamaba","year":"2021","journal-title":"Intern Med"},{"key":"2025082700010910000_18.2.e258863.17","article-title":"Another Fatality Due to Postpartum Group A Streptococcal Endometritis in the Modern Era","volume":"11","author":"Singhal","year":"2019","journal-title":"Cureus"},{"key":"2025082700010910000_18.2.e258863.18","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1002\/ccr3.2799","article-title":"A rare case of group A streptococcal toxic-shock syndrome in a postpartum adolescent leading to multi-organ failure","volume":"8","author":"Cortez Granados","year":"2020","journal-title":"Clin Case Rep"},{"key":"2025082700010910000_18.2.e258863.19","doi-asserted-by":"publisher","DOI":"10.1086\/376630"},{"key":"2025082700010910000_18.2.e258863.20","article-title":"Clinical Efficacy of Intravenous Immunoglobulins in Management of Toxic Shock Syndrome: An Updated Literature Review","volume":"13","author":"Amreen","year":"2021","journal-title":"Cureus"},{"key":"2025082700010910000_18.2.e258863.21","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw248"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-258863","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:01:20Z","timestamp":1756278080000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-258863"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":21,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,11]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bcr-2023-258863"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-258863","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}