# Crystalline lens dislocation as a presenting sign of Streptococcus pyogenes invasive infections

## TL;DR

This paper reports two cases where lens dislocation was a sign of severe Streptococcus pyogenes infection, emphasizing the importance of early treatment.

## Contribution

The paper presents two new clinical cases linking lens dislocation to specific GAS strains (ST28 and ST433) in invasive infections.

## Key findings

- Lens dislocation can be a presenting sign of invasive GAS infection.
- Early and aggressive treatment with antibiotics preserved ocular structures in one patient.
- Two specific GAS sequence types, ST28 and ST433, were identified in the cases.

## Abstract

Introduction. To describe two cases of crystalline lens dislocation as a presenting feature of invasive group A Streptococcus (GAS) infection and its management.

Case presentation. We report on a 58-year-old woman and a 36-year-old man who presented in 2024 with acute vision loss and severe ocular and systemic symptoms. Both patients were found to have lens dislocation and were diagnosed with invasive GAS infection. The 58-year-old woman had a complicated clinical course leading to enucleation, while the 36-year-old man responded favourably to early and aggressive treatment with systemic and intravitreal antibiotics. The responsible GAS strains were sequence type (ST) 28 and ST433, respectively.

Conclusion. These cases highlight the importance of recognizing crystalline lens dislocation as a potential sign of ocular GAS infection. Two specific strain types of GAS associated with these findings, ST28 and ST433, are reported. In patients with GAS sepsis presenting with corneal oedema and zonular loss, clinicians should immediately initiate treatment, including intravitreal antibiotic injections and systemic therapy. Prompt and aggressive management can be crucial in preserving ocular structures.