260 - A Rare Case of Severe Group B Streptococcal Infection with Toxic Shock-like Syndrome and Diffuse Metastatic Infection.

Background: The incidence of invasive Group B streptococcal (GBS) infection has been increasing in the past decade and is currently at 10.9 cases per 100,000 population. GBS toxic shock-like syndrome is rare, with few cases reported over the past decade. The presumed etiology is the production of an uncharacterized pyrogenic toxin by certain strains.

Methods: We present a unique case of invasive GBS infection complicated by severe GBS-mediated toxic shock-like syndrome (TSLS) and diffuse metastatic infection.

Results: A 62-year-old obese male with diabetes mellitus presented with pain, swelling, and redness of the right shoulder and ankle for one week after a fall.  Vitals were remarkable for tachycardia to 106 BPM and fever of 101°F with labs showing a leukocytosis to 23,500 u/L. The patient was started on ceftriaxone IV but continued to develop worsening fever, leukocytosis, encephalopathy, diffuse extremity pain, and whole-body macular erythema at 48 hours. Blood cultures grew GBS and TSLS was suspected. Adjunct clindamycin was started. MRI of the extremities demonstrated abscesses of the right levator scapulae, posterior scalene, brachioradialis, and right ankle. MRI of the spine showed epidural abscesses at L3-L5 and septic arthritis of the spinal facets at L4-L5.  Operative abscess removal with joint washouts were performed by neurosurgery and orthopedics, and the patient symptomatically improved within 2 weeks on IV ceftriaxone. He was subsequently continued on cefazolin for 10 weeks and did well at follow-up.Right elbow showing a characteristic flat, macular erythema of toxic shock-like syndrome.
Left arm with macular erythema.
MRI showing spinal epidural abscesses at L3-L5 spinal levels (arrows).


Conclusion: Invasive metastatic Group B Streptococcus infection in non-pregnant adults presenting with  TSLS is rare. To our knowledge, there has never been a case of GBS infection causing TSLS with rapidly developing florid metastatic infection including epidural abscess development, septic arthritis, and musculoskeletal abscesses. This case highlights the wide range of infectious possibilities associated with severe GBS infection.