A previously healthy 22-year old woman died after contracting a rare form of sepsis arising from an infection that may have been caused by a minor scratch to the woman’s leg while playing sport.
In a case documented by medics at the Emergency Department (ED) at University Hospital Limerick (UHL), the young woman presented at the ED with a two day history of worsening right groin pain, progressive leg swelling and new-onset shortness of breath.
In the paper entitled ‘When Sepsis Kills: A Fatal Cascade of Invasive Group A Streptococcal Sepsis’ in the new June edition of the Irish Medical Journal (IMJ), medics at UHL’s ED department state it was reported that the woman had recently recovered from an upper respiratory tract infection and “she also had a minor scratch to the affected leg sustained while playing sport”.
On arrival at the UHL ED, the young woman was triaged as Category 2 and transferred directly to the resuscitation area.
The medics that despite antibiotics, emergency surgery, and advanced life support, the patient died of multi-organ failure.
In the paper, Dr Nancy Brulinska of the ED at UHL, says that the case illustrates the rapid progression and diagnostic complexity of a rare and severe form of sepsis, Invasive Group A Streptococcal (iGAS).
The medics stated that an iGAS infection can mimic a different condition, thromboembolic disease, and requires urgent recognition.
Dr Brulinska stated that the case highlights the severe nature of iGAS infection in a previously healthy young adult following a minor trauma.
Dr Brulinska states that the woman’s small leg abrasion combined with preceding pharyngitis – or sore throat – likely facilitated the onset of Streptococcus pyogenes.
Dr Brulinska stated that the initial impression of deep-vein thrombosis reflects a well-recognised diagnostic pitfall in such a case.
The paper states that early diagnosis for iGAS “is challenging, as initial features may overlap with deep-vein thrombosis or cellulitis”.
Discussing the treatment of the woman, medics report that after the woman was brought to the resuscitation area, on examination, her right lower limb was tense, markedly swollen, cool, and mottled.
Initial laboratory investigations demonstrated severe metabolic, inflammatory, and haematological derangement and various tests carried out on the patient were consistent with septic shock complicated by acute kidney injury and hepatic failure – or acute liver failure.
The young woman was admitted to intensive care for refractory shock and a CT scan of the woman’s right leg demonstrated extensive soft-tissue swelling of the right thigh and calf with marked muscle enlargement.
The paper states that a deep-vein thrombosis was present but deemed insufficient to explain the severity of limb swelling or systemic deterioration.
Shortly after ICU admission, the patient suffered two episodes of cardiac arrest and the return of spontaneous circulation was achieved following advanced life support.
The woman remained dependent on mechanical ventilation and the woman subsequently died from multiple organ failure.
