Necrotizing Cervical and Uterine Infection in the Postpartum Period Caused by Group A Streptococcus

BACKGROUND: Group A Streptococcus, once the most common causes of puerperal sepsis, is now a rare cause of postpartum fever. CASE: A term 27-year-old woman presented after spontaneous membrane rupture. After an uncomplicated vaginal delivery, she became febrile without a source of infection. Despite two different antibiotic regimens, she remained febrile for 3 days. A computed tomography scan showed a wedge-shaped discontinuity in the anterior uterus suggesting uterine infection with early abscess formation. The patient underwent exploratory laparotomy and hysterectomy, with an uneventful postoperative course. Uterine pathology revealed a necrotizing infection within the uterus and cervix from Group A Streptococcus. CONCLUSION: Puerperal sepsis from Group A Streptococcus can be a cause of necrotizing infection following delivery. Physicians should be aware of the resurgence of this potentially fatal pathogen.