# A Diagnostic Dilemma: Clindamycin-Resistant Group A Streptococcal Toxic Shock Syndrome Leading to Acute Respiratory Distress Syndrome (ARDS) With Multiple Possible Sources

## TL;DR

A healthy woman developed severe strep infection from her genitourinary tract, leading to life-threatening complications but eventually recovered with proper treatment.

## Contribution

Highlights an unusual genitourinary source of STSS and effective treatment strategies for severe strep infections.

## Key findings

- A previously healthy woman developed STSS from a genitourinary Group A Streptococcus infection.
- The patient recovered with antibiotics and prone ventilation for ARDS without needing surgery.
- Unusual presentations of Group A Strep infections can rapidly progress to severe illness.

## Abstract

Group A Streptococcal (GAS) infections can potentially progress into streptococcal toxic shock syndrome (STSS) with multiorgan failure. Even with a benign presentation, GAS can rapidly lead to fatal necrotizing infections. While myositis and cutaneous infections are the typical initial presentation of STSS, genitourinary infections are a less common source. This report presents a case of a previously healthy woman with the chief complaint of ankle pain who subsequently developed streptococcal toxic shock syndrome and multiorgan failure from a Group A streptococcus infection of the genitourinary tract. She was treated with antibiotics and medical management for her septic shock and required prone ventilation for her acute respiratory distress syndrome (ARDS) but eventually recovered without surgery. This case highlights the importance of recognizing unusual presentations of Group A Strep infections, which have the potential to lead to rapid deterioration in patients. Also described are antibiotic and ventilator strategies that can be used to treat these severe systemic infections.