title: Group A streptococcal toxic shock syndrome developing in the third trimester of pregnancy.
abstract: BACKGROUND
  Group A streptococcal (GAS) toxic shock syndrome (TSS) is an uncommon, but life-threatening infection during pregnancy and should be considered in rapid onset of shock. Most cases described in the literature have occurred in the puerperium. We report a case of GAS TSS occurring during the third trimester of pregnancy in a previously healthy woman.
  
  
  METHODS
  A 31-year-old female, who was 34 weeks pregnant, presented with fevers and a prodromal 'flu-like' illness. She rapidly developed shock and multiorgan failure. Blood cultures revealed GAS bacteremia and the patient met criteria for streptococcal TSS. Despite her eventual recovery, her infant died on postpartum day 15 as a consequence of the mother's TSS.
  
  
  CONCLUSIONS
  This case is unusual in that there were no identifiable initiating events or source of the streptococcal infection, and the TSS developed during pregnancy rather than after delivery. Early recognition of GAS infections is important given the rapid onset and high morbidity and mortality associated with these infections. This is the first reported case utilizing intravenous immunoglobulin for GAS TSS in the puerperium.
authors.affiliation: Internal Medicine Department, Naval Medical Center San Diego, San Diego, CA 92134, USA. nfcrum@nmcsd.med.navy.mil
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum
authors.forename: Helen M
authors.initials: HM
authors.lastname: Chun
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gaylord
authors.forename: Braden R
authors.initials: BR
authors.lastname: Hale
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000382:microbiology; D011263:Pregnancy Trimester, Third; D012772:Shock, Septic / Q000175:diagnosis* / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification*