# Invasive Group A Streptococcal Infection Following Nasal Self-Packing With Facial Tissue: A Case Report

## TL;DR

A man with multiple myeloma developed a severe streptococcal infection after self-packing his nose with facial tissue, leading to septic shock.

## Contribution

Highlights how nasal self-packing can lead to invasive group A streptococcal infection in immunocompromised individuals.

## Key findings

- Nasal self-packing with facial tissue preceded the onset of invasive group A streptococcal infection.
- The infection led to septic shock requiring norepinephrine infusion in an immunocompromised patient.
- The causative strain was identified as emm49 through emm typing.

## Abstract

Invasive group A streptococcal infection (iGAS) can develop rapidly in immunocompromised individuals. We describe the case of a 66-year-old man with multiple myeloma who was admitted for chemotherapy and subsequently developed iGAS. He had been performing nasal self-packing with facial tissue for nasal discharge and hemorrhage. During hospitalization, he developed erythema, pain, and swelling around the nose and experienced a sudden onset of septic shock characterized by profound hypotension requiring norepinephrine infusion. Streptococcus pyogenes was detected in blood cultures, and treatment with beta-lactam antibiotics and clindamycin led to rapid improvement. Follow-up testing revealed that emm typing identified the strain as emm49. This case highlights that in immunocompromised individuals, trivial self-care like nasal self-packing can precipitate severe infections such as iGAS and shock, emphasizing the need for clinical vigilance.