Group-A-streptococcus-(GAS)-induced toxic shock syndrome (TSS) is uncommon, but carries a high risk of maternal mortality during pregnancy. The onset of GAS-TSS has been reported mostly during the puerperium.

We report a case of a 25-year-old Para 1 whom presented to us on day 7 post -delivery with complaints of fever and severe thigh pain.  She had a spontaneous vaginal delivery with episiotomy at 38 weeks 4 days. Her delivery was otherwise uneventful whereby she delivered a healthy female infant. Both mother and child were discharged the following day. On the very next day, she complained of right buttock pain extending into the thigh. The pain gradually became unbearable especially on sitting down. She developed fever and felt generally unwell. On hospital admission, patient was in septic shock with coma. There was evidence disseminated intravascular coagulation (DIC), and multi-organ failure. On examination, the patient had extensive bruising – with almost scarlet like vesicle formation over her right buttock extending into her thigh. The patient was subsequently intubated and treated with intravenous antibiotics and Immunoglobulins. Despite a concerted multidisciplinary effort, unfortunately, she died on day 4 of admission in the ICU. Cultures from blood, subcutaneous tissue and vaginal swab, all revealed GAS bacteria. She was therefore diagnosed as having GAS-TSS.

GAS-TSS in pregnancy is rare. However, once the infection occurs in a pregnant woman, it rapidly develops into sepsis with multi-organ failure. Therefore, early recognition and intensive treatment for GAS during pregnancy is vital.