Clinical Scorecard: Invasive Group A Streptococcus Infection Leading to Toxic Shock Syndrome, Myositis, and Likely Necrotizing Fasciitis in a Patient with Pemphigus Vulgaris

At a Glance

Key Highlights

• 50% prevalence of skin and soft tissue infections in pemphigus vulgaris patients

• Mortality associated with invasive group A streptococcal infection ranges from 70% to 100%

• First report of invasive group A streptococcal infection during active pemphigus vulgaris flare

• Empirical antibiotic therapy included ceftriaxone, vancomycin, and piperacillin-tazobactam

• Clindamycin was used for toxin suppression in the setting of severe infection

Guideline-Based Recommendations

Diagnosis

• Diagnosis established by clinical presentation and blood cultures

Management

• Initiate broad-spectrum antibiotics and adjust based on culture results

• Consider high-dose intravenous penicillin G for severe infections

Monitoring & Follow-up

• Monitor for signs of compartment syndrome and necrotizing fasciitis

• Regularly assess inflammatory markers and leukocytosis

Risks

• High morbidity and mortality associated with invasive group A streptococcal infections

• Potential for complications due to immunosuppressive therapy in pemphigus vulgaris

Patient & Prescribing Data

Individuals with pemphigus vulgaris experiencing severe exacerbations

Combination therapy with clindamycin and high-dose penicillin G is critical for managing severe infections

Clinical Best Practices

• Employ a multidisciplinary approach for complex cases involving infections in immunocompromised patients

• Early identification and intervention for signs of severe infection are essential

Related Resources & Content

1. Association of serious infections with pemphigus and pemphigoid: analysis of the Nationwide Inpatient Sample.

2. MDSpire News — Necrotizing Fasciitis Following Minor Bike Injury

3. Infection — Clostridium septicum-Induced Gas Gangrene in a Patient with Neutropenia

4. Infection — The Evolving Epidemiology of Invasive Group A Streptococcus in Tropical Australia: Insights from a 21-Year Population-Based Data Analysis

5. International Journal of Infectious Diseases — Skin biopsy PCR enables rapid diagnosis of tattoo-associated staphylococcal toxic shock syndrome

6. Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

7. Severe Group A Streptococcus Infection among Children, France, 2022–2024 - Volume 31, Number 9—September 2025 - Emerging Infectious Diseases journal - CDC

8. Association of serious infections with pemphigus and pemphigoid: analysis of the Nationwide Inpatient Sample.