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Surgery
Unexpected sepsis due to Group A beta haemolytic Streptococcus following total thyroidectomy
  1. Hasitha Udayakumara1,
  2. Emmie Stewart-Parker2,
  3. Osama Shattarah2 and
  4. Johnathan G Hubbard3
  1. 1Endocrine Surgery, Guy's and St Thomas’ Hospitals NHS Trust, London, UK
  2. 2Surgery, Guy's and St Thomas’ Hospitals NHS Trust, London, UK
  3. 3General and Endocrine Surgery, Guy's and St Thomas’ Hospitals NHS Trust, London, UK
  1. Correspondence to Dr Hasitha Udayakumara; hasithauday{at}gmail.com

Abstract

Thyroidectomy is a clean surgery, with the presentation of postoperative infections being uncommon and an exceedingly rare incidence of postoperative sepsis.

A female patient in her early 80s became acutely unwell following total thyroidectomy within the immediate postoperative period, with features suggestive of sepsis. She developed new-onset atrial fibrillation (AF), and her care was escalated to the intensive treatment unit (ITU) on the same day postoperatively. While in the ITU, she deteriorated with multiorgan failure (MOF). There was no evidence of a surgical site infection (SSI).

Beta haemolytic lancefield Group A Streptococcus (GAS) was isolated from positive blood cultures, confirming the diagnosis of streptococcal toxic shock syndrome (TSS). She was treated with targeted antibiotics and intravenous immunoglobulin (IG) and received supportive care for MOF.

In our case, sepsis developed in the immediate postoperative period of total thyroidectomy. A high index of suspicion and prompt treatment are required to minimise the risks of morbidity and mortality.

  • Thyroid disease
  • Head and neck surgery

https://doi.org/10.1136/bcr-2024-264223

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    Footnotes

    • X @hasithaud

    • Contributors The following authors were responsible for drafting the text, sourcing and editing clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: HU, ESP, OS, JGH. The following authors gave final approval of the manuscript: HU, ESP, OS, JGH. Guarantor: JGH.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.