Crystalline lens dislocation as a presenting sign of Streptococcus pyogenes invasive infections

Introduction To describe two cases of crystalline lens dislocation as a presenting feature of invasive group A Streptococcus (GAS) infection and its management. Case presentation We report on a 58-year-old female and a 36-year-old male who presented with acute vision loss and severe ocular symptoms. Both patients were found to have lens dislocation and were diagnosed with invasive GAS infection. The 58-year-old female had a complicated clinical course leading to enucleation, while the 36-year-old male responded favorably to early and aggressive treatment with systemic and intravitreal antibiotics. The responsible GAS strains were sequence type (ST) 28 and ST433, respectively. Conclusion These cases highlight the importance of recognizing crystalline lens dislocation as a potential sign of ocular GAS infection. Two specific strain types of GAS associated with these findings, ST28 and ST433, are reported. In patients with GAS sepsis presenting with corneal edema and zonular loss, clinicians should immediately initiate treatment, including intravitreal antibiotic injections and systemic therapy. Prompt and aggressive management can be crucial in preserving ocular structures.