Successful treatment of severe acute respiratory distress syndrome due to Group A streptococcus induced toxic shock syndrome in the third trimester of pregnancy-effectiveness of venoarterial extracorporeal membrane oxygenation: A case report

J Obstet Gynaecol Res. 2020 Jan;46(1):167-172. doi: 10.1111/jog.14138. Epub 2019 Oct 8.


We report a case of Group A streptococcal infection-induced toxic shock syndrome (GAS-TSS) with severe acute respiratory distress syndrome (ARDS), successfully treated with venoarterial extracorporeal membrane oxygenation (V-A ECMO). A 31-year-old woman was transferred due to high fever, continuous uterine contractions and fetal bradycardia at 31 weeks of gestation. She was in a shock status on arrival, and as fetal heart beat disappeared, we canceled the cesarean section and took priority in maternal rescue. At 21 h after the admission, pulseless ventricular tachycardia occurred, and V-A ECMO was introduced after defibrillation, which dramatically improved her respiratory and circulatory conditions. On the 3rd day, GAS was isolated from blood culture. The patient was freed from V-A ECMO on the 5th day and was discharged on the 25th day without permanent impairment. V-A ECMO should be considered as an effective therapeutic option against ARDS and circulation failure in GAS-TSS during pregnancy.

Keywords: Group A streptococcus; continuous hemodiafiltration; extracorporeal membrane oxygenation; pregnancy; toxic shock syndrome.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Bradycardia / microbiology
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Fetal Death
  • Fetal Diseases / microbiology
  • Humans
  • Pregnancy
  • Pregnancy Complications, Infectious / microbiology
  • Pregnancy Complications, Infectious / therapy*
  • Pregnancy Trimester, Third
  • Respiratory Distress Syndrome / microbiology
  • Respiratory Distress Syndrome / therapy*
  • Shock, Septic / microbiology
  • Shock, Septic / therapy*
  • Streptococcal Infections / complications*
  • Streptococcal Infections / microbiology
  • Streptococcus pyogenes*
  • Treatment Outcome