INFECCIÓN INVASIVA POR STREPTOCOCCUS PYOGENES EN PUERPERIO TARDÍO CON SÍNDROME DE SHOCK TÓXICO ESTREPTOCÓCICO Y FASCITIS NECROTIZANTE: REPORTE DE CASO
Authors/Creators
- 1. Facultad de Salud, Universidad Libre. Cali, Colombia
- 2. Hospital San Juan de Dios
-
3.
Universidad Libre de Colombia
- 4. Hospital Regional de Sogamoso. Sogamoso, Colombia
Description
Tipo de artículo: Caso clínico
Introducción: La infección invasiva por Streptococcus pyogenes (iGAS) constituye una entidad poco frecuente, pero de alta gravedad, con curso clínico rápidamente progresivo y elevada mortalidad. El puerperio representa un periodo de mayor susceptibilidad para infecciones invasivas por este microorganismo, especialmente en presencia de cesárea u otras complicaciones obstétricas. Entre sus manifestaciones más graves se encuentran el síndrome de shock tóxico estreptocócico y la fascitis necrotizante; sin embargo, el compromiso extrapélvico durante el puerperio es excepcional y ha sido escasamente descrito.
Caso clínico: mujer de 29 años con obesidad, en puerperio tardío (tres meses) posterior a embarazo complicado por preeclampsia grave, que consultó por fiebre, síntomas constitucionales y deterioro respiratorio rápidamente progresivo. Ingresó en shock con falla multiorgánica y neumonía multilobar con derrame pleural bilateral, compatible con infección invasiva grave. Durante la hospitalización desarrolló lesiones cutáneas y trombosis vascular periférica, con progresión a fascitis necrotizante extensa del miembro superior izquierdo. El panel molecular respiratorio fue positivo para S. pyogenes, considerándose infección invasiva por iGAS con síndrome de shock tóxico estreptocócico. Requirió ventilación mecánica, soporte vasopresor múltiple, terapia de reemplazo renal continua y manejo quirúrgico seriado.
Discusión: La infección invasiva por Streptococcus pyogenes en el puerperio es infrecuente y de rápida progresión. Este caso destaca por la combinación de neumonía multilobar, síndrome de shock tóxico estreptocócico y fascitis necrotizante extrapélvica, una presentación excepcional. El diagnóstico temprano, el tratamiento antimicrobiano dirigido y el control precoz del foco fueron fundamentales para la evolución favorable.
Conclusión: El reconocimiento temprano de la iGAS puerperal y el manejo multidisciplinario con antibioticoterapia dirigida y control del foco fueron claves para una evolución favorable.
Abstract (English)
Article type: Clinical case
Introduction: invasive Streptococcus pyogenes infection (iGAS) is an uncommon but potentially life-threatening condition, with a rapidly progressive clinical course and high mortality. The puerperium represents a period of increased susceptibility to invasive infections by this microorganism, particularly in the presence of cesarean delivery or other obstetric complications. Among its most severe manifestations are streptococcal toxic shock syndrome and necrotizing fasciitis; however, extrapelvic involvement during the puerperium is exceptional and has been scarcely described.
Case report: a 29-year-old woman with obesity, in the late postpartum period (three months) following a pregnancy complicated by severe preeclampsia, presented with fever, constitutional symptoms, and rapidly progressive respiratory deterioration. She was admitted in shock with multiorgan failure and multilobar pneumonia with bilateral pleural effusion, consistent with severe invasive infection. During hospitalization she developed cutaneous lesions and peripheral vascular thrombosis, progressing to extensive necrotizing fasciitis of the left upper limb. The respiratory molecular panel was positive for S. pyogenes, consistent with invasive iGAS infection with streptococcal toxic shock syndrome. She required mechanical ventilation, multiple vasopressors, continuous renal replacement therapy, and serial surgical management.
Discussion: invasive Streptococcus pyogenes infection in the puerperium is uncommon and rapidly progressive. This case is notable for the combination of multilobar pneumonia, streptococcal toxic shock syndrome, and extrapelvic necrotizing fasciitis, an exceptional presentation. Early diagnosis, targeted antimicrobial therapy, and prompt source control were fundamental to the favorable outcome.
Conclusion: early recognition, timely microbiological confirmation, and a multidisciplinary approach with targeted antibiotic therapy and surgical source control represent key elements of management associated with a favorable outcome in this case of iGAS in the puerperal population.
Files
sanum_v10_n4_a14.pdf
Additional details
Additional titles
- Translated title (English)
- LATE POSTPARTUM INVASIVE STREPTOCOCCUS PYOGENES INFECTION WITH STREPTOCOCCAL TOXIC SHOCK SYNDROME AND NECROTIZING FASCIITIS: A CASE REPORT
Dates
- Collected
-
2026-06-29manuscrito recibido
- Accepted
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2026-08-04evaluación doble ciego
- Available
-
2026-10-30publicación en numero de la revista
Software
- Repository URL
- https://revistacientificasanum.com/
- Development Status
- Active
References
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