title: [A postpartum woman with toxic shock syndrome: group A streptococcal infection, a much feared postpartum complication.]
abstract: The development of toxic shock syndrome (TSS) after an invasive group A streptococcal (GAS) infection in the postpartum period is a much feared complication. The mortality rate of TSS with necrotizing fasciitis is 30 to 50%.
  
  
  
  We present the case of a woman with atypical pelvic pain which was the first symptom of toxic shock syndrome as a consequence of a GAS infection. Clinical deterioration necessitated a hysterectomy. Also a fasciotomy was performed as consequence of lower extremity compartment syndrome. After this, multiple debridement operations were necessary, followed by split skin grafts.
  
  
  
  This case illustrates the extremely serious complications of GAS infection. In some cases aggressive surgical intervention is necessary, in addition to an optimal antibiotic treatment regime. Ideally, the treatment of a GAS-induced TSS should be managed by a multidisciplinary medical team.
authors.affiliation: Catharina Ziekenhuis, Eindhoven.
authors.forename: K
authors.initials: K
authors.lastname: Abbink
authors.forename: J C
authors.initials: JC
authors.lastname: Kortekaas
authors.forename: M P
authors.initials: MP
authors.lastname: Buise
authors.forename: J
authors.initials: J
authors.lastname: Dokter
authors.forename: S M I
authors.initials: SM
authors.lastname: Kuppens
authors.forename: T H M
authors.initials: TH
authors.lastname: Hasaart
mesh_terms: D000328:Adult; D003646:Debridement; D005260:Female; D006801:Humans; D007044:Hysterectomy; D017699:Pelvic Pain / Q000209:etiology; D049590:Postpartum Period; D011645:Puerperal Infection / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D012772:Shock, Septic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification