Fulminant invasive group A streptococcal infection following influenza A during pregnancy resulting in maternal near-miss

Invasive group A streptococcal (iGAS) infection during pregnancy is rare but associated with disproportionately high maternal mortality. Influenza infection has been shown to increase the virulence of Streptococcus pyogenes , and a global resurgence of iGAS has been reported in the post-COVID-19 era.

We report a woman in her early 30s at 32 weeks of gestation who developed fulminant iGAS following influenza A infection. Despite antiviral therapy and repeatedly negative rapid antigen tests for group A streptococcus, her condition rapidly deteriorated, resulting in septic shock, acute respiratory distress syndrome and intrauterine fetal death. Intensive multidisciplinary management including emergency delivery, continuous haemodiafiltration and veno-venous extracorporeal membrane oxygenation was required. The patient survived but required right lower limb amputation due to severe ischaemic complications.

This case highlights the potential for influenza to precipitate life-threatening iGAS during pregnancy and underscores the need for early recognition when pregnant patients with influenza show unexpected clinical deterioration.