{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T10:44:47Z","timestamp":1772621087298,"version":"3.50.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Invasive\n                      <jats:italic>Streptococcus pyogenes<\/jats:italic>\n                      infection is exceedingly rare in patients with closed fractures. However, it can precipitate life-threatening necrotizing soft-tissue infection and streptococcal toxic shock syndrome once it occurs. Early recognition and aggressive multidisciplinary management are essential for survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We presented a patient who sustained closed fracture of the upper segment of the left femur due to a traffic accident. He had a history of acute pharyngitis 10\u202fdays ago. The patient experienced fever on the second day after admission, with his body temperature ranging from 38.5 \u00b0C to 38.8 \u00b0C. He developed rapidly progressive swelling and severe pain at the fracture site on the third day, accompanied by high fever of 40.1 \u00b0C, tachypnea, and tachycardia, with mottled rash over the local skin, followed by hypotension, oliguria and a rise of serum creatinine. Emergent fasciotomy and decompression were performed, and the thigh musculature of patient was dusky-red and non-viable. Debridement was performed to remove the necrotic tissue. Subsequently, the patient rapidly developed to multiple organ dysfunction with profoundly elevated inflammatory markers. Thigh amputation surgery was undertaken to save his life. The wound secretion, blood culture, and plasma next-generation sequencing (NGS) all confirmed a diagnosis of streptococcal infection. The patient then underwent several times of debridement to remove necrotic tissue. Meanwhile, he took sensitive antibiotic therapy, aggressive fluid resuscitation and organ function support. Ultimately, his condition improved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This case underscored the catastrophic potential of closed fractures complicated by necrotizing soft tissue infections caused by\n                      <jats:italic>S. pyogenes<\/jats:italic>\n                      , highlighting the critical need for heightened vigilance in patients with a recent history of\n                      <jats:italic>Streptococcus<\/jats:italic>\n                      exposure. Early and aggressive surgical intervention, along with multidisciplinary collaboration, is essential. Additionally, the role of prompt pathogen culture testing and advanced diagnostic techniques, such as NGS, in pathogen identification is emphasized.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1795714","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:41:35Z","timestamp":1772602895000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Fatal Streptococcus pyogenes infection secondary to closed femoral fracture"],"prefix":"10.3389","volume":"13","author":[{"given":"Danni","family":"Zhong","sequence":"first","affiliation":[{"name":"Clinical Pharmacy Department, Ningbo No. 6 Hospital","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiajie","family":"He","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Ningbo No. 6 Hospital","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Ningbo No. 6 Hospital","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunping","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Ningbo No. 6 Hospital","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1016\/j.amjmed.2020.02.050","article-title":"Multisystemic involvement: streptococcal toxic shock syndrome","volume":"133","author":"Fernandez-Nieto","year":"2020","journal-title":"Am J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e10","DOI":"10.1093\/cid\/ciu444","article-title":"Practice guidelines for the diagnosis and 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Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e86","DOI":"10.1093\/cid\/cis629","article-title":"Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the infectious diseases society of America","volume":"55","author":"Shulman","year":"2012","journal-title":"Clin Infect Dis"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1001\/jamasurg.2024.3365","article-title":"Necrotizing soft tissue infections: a review","volume":"159","author":"McDermott","year":"2024","journal-title":"JAMA Surg"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1302\/0301-620X.82B2 .9799","article-title":"Acute compartment syndrome. 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