First Reported Australian case of Fatal Streptococcal Group B Pneumonia (serotype 21) Necrotising fasciitis complicated by Toxic Shock Like Syndrome – A Case report and review

INTRODUCTION: NF is a life-threatening infection and progressive disease resulting in widespread fulminant tissue destruction. It is rarely caused by Group B Streptococcus pneumonia. Early management with surgical removal of devitalized tissue and urgent antibiotic administration are key therapies. AIM: The aim of this report is to highlight the importance of atypical microorganisms seen in NF. METHOD: A case presentation and cohort summary of reported NF cases secondary to SPN from the year 2011 to 2020. RESULTS: We report the case of a 67-year-old male, not on immune-suppressive medications, admitted to our intensive care unit with septic shock and multiorgan failure secondary to left leg NF following a 3-week history of cactus prick with an SPN bacteraemia and LRINEC score of 5 on admission. He required multiple surgical debridements and was commenced on appropriate antibiotics. Despite continuous vasopressor supportive therapy, high flux CRRT, and IVIG, our patient died after an 8-day inpatient stay. A 10-year review showed only 5 reported GBSPn NF cases with an associated mortality rate of 40%. CONCLUSION: A high clinical suspicion of SPN infections in NF is required to avoid high mortality with early diagnosis and targeted anti-microbial therapy. Severity scores may not align with clinical severity.