Goldfarb Smadar, Korem Maya, Rubin Limor
Department of Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
IDCases. 2025 Aug 18;41:e02348. doi: 10.1016/j.idcr.2025.e02348. eCollection 2025.
Group A Strep (GAS) infection associated with intrauterine devices (IUDs) is rare and only sporadically described following IUDs removal. We present a unique case of toxic shock syndrome presenting with pyogenic ascites following IUD removal in a 29 year old otherwise healthy woman. Upon admission, the patient primarily complained of abdominal pain and diarrhea and was found to have acute kidney injury. Despite empiric antibiotic therapy, her condition deteriorated, developing acute respiratory distress syndrome (ARDS), worsening renal failure, ascites, and a desquamating rash on her palms. All cultures obtained from blood, urine, stool, and peritoneal fluid were negative. However, 16S rRNA PCR testing of the peritoneal fluid confirmed the diagnosis of GAS. Source control and full recovery were achieved following an exploratory laparotomy with abdominal washouts in addition to antibiotics administration. This report adds to the limited literature on GAS infections associated with IUDs and demonstrates the need for heightened clinical suspicion and advanced diagnostic techniques in similar scenarios.
A组链球菌（GAS）感染与宫内节育器（IUD）相关的情况罕见，仅在取出IUD后有零星报道。我们报告了一例独特的中毒性休克综合征病例，一名29岁原本健康的女性在取出IUD后出现化脓性腹水。入院时，患者主要诉说腹痛和腹泻，被发现有急性肾损伤。尽管进行了经验性抗生素治疗，她的病情仍恶化，发展为急性呼吸窘迫综合征（ARDS）、肾衰竭加重、腹水，手掌出现脱皮性皮疹。从血液、尿液、粪便和腹腔液中获取的所有培养物均为阴性。然而，腹腔液的16S rRNA PCR检测确诊为GAS。除了给予抗生素外，通过剖腹探查和腹腔冲洗实现了源头控制并完全康复。本报告补充了关于与IUD相关的GAS感染的有限文献，并表明在类似情况下需要提高临床怀疑度和采用先进的诊断技术。
