Matsumoto Shuhei, Masuda Takuya, Minemura Nobuyoshi, Nakajima Hiroyoshi, Tatsuno Keita
Department of Hematology and Oncology, University of Tokyo Hospital, Tokyo, Japan.
Department of General Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan.
Am J Case Rep. 2025 Apr 27;26:e947291. doi: 10.12659/AJCR.947291.
BACKGROUND Group A Streptococcus (GAS, Streptococcus pyogenes) is a gram-positive human-exclusive pathogen responsible for various types of infections. The incidence of invasive GAS infections, which can be severe and are associated with Streptococcal toxic shock syndrome (STSS), is increasing worldwide. CASE REPORT A 75-year-old woman with a past medical history of cervical cancer surgically treated 10 years ago and dyslipidemia presented to the Emergency Department with fever, swollen eyelids, and difficulty moving her body. Initially, she was diagnosed with erysipelas based on her typical facial manifestation. Cefazolin was initiated, but it was changed to Ampicillin + Clindamycin due to concerns about invasive GAS and STSS. Despite these antibiotics, her edema deteriorated and her neck became swollen on Day 3. She reported difficulty breathing, and inspiratory stridor subsequently appeared. CT showed facial and pharyngeal edema. We urgently intubated her with a bronchoscope, which revealed a swollen and reddish epiglottis. Her airway symptoms and swollen neck disappeared on Day 11, and she was extubated. On Day 18, her antibiotic treatment was completed. CONCLUSIONS We describe a patient with invasive GAS infections whose initial manifestation was typical of erysipelas, but she eventually required intubation due to complicated epiglottitis. Even when GAS disease is treated with antibiotics, it may be difficult to prevent subsequent invasive GAS disease. Regardless of the initial diagnosis and treatment, careful monitoring is vital. When invasive GAS infection is suspected, there is a need to prepare for urgent intervention.
背景 A 组链球菌（GAS，化脓性链球菌）是一种革兰氏阳性的仅感染人类的病原体，可导致多种类型的感染。侵袭性 GAS 感染的发病率在全球范围内呈上升趋势，这种感染可能很严重，并与链球菌中毒性休克综合征（STSS）相关。病例报告 一名 75 岁女性，有 10 年前接受过宫颈癌手术治疗及血脂异常的病史，因发热、眼睑肿胀和身体活动困难就诊于急诊科。最初，根据其典型的面部表现诊断为丹毒。开始使用头孢唑林治疗，但由于担心侵袭性 GAS 和 STSS，改为氨苄西林 + 克林霉素治疗。尽管使用了这些抗生素，她的水肿在第 3 天仍恶化，颈部也肿胀起来。她报告呼吸困难，随后出现吸气性喘鸣。CT 显示面部和咽部水肿。我们紧急用支气管镜为她插管，发现会厌肿胀且发红。她的气道症状和颈部肿胀在第 11 天消失，随后拔管。第 18 天，她完成了抗生素治疗。结论 我们描述了一名侵袭性 GAS 感染患者，其最初表现为典型的丹毒，但最终因并发会厌炎而需要插管。即使使用抗生素治疗 GAS 疾病，也可能难以预防随后的侵袭性 GAS 疾病。无论初始诊断和治疗如何，仔细监测至关重要。当怀疑有侵袭性 GAS 感染时，需要准备紧急干预措施。
