BACKGROUND: Group A Streptococcus (GAS, Streptococcus pyogenes) is a gram-positive human-exclusive pathogen responsible for various types of infections. The incidence of invasive GAS infections, which can be severe and are associated with Streptococcal toxic shock syndrome (STSS), is increasing worldwide.

CASE REPORT: A 75-year-old woman with a past medical history of cervical cancer surgically treated 10 years ago and dyslipidemia presented to the Emergency Department with fever, swollen eyelids, and difficulty moving her body. Initially, she was diagnosed with erysipelas based on her typical facial manifestation. Cefazolin was initiated, but it was changed to Ampicillin + Clindamycin due to concerns about invasive GAS and STSS. Despite these antibiotics, her edema deteriorated and her neck became swollen on Day 3. She reported difficulty breathing, and inspiratory stridor subsequently appeared. CT showed facial and pharyngeal edema. We urgently intubated her with a bronchoscope, which revealed a swollen and reddish epiglottis. Her airway symptoms and swollen neck disappeared on Day 11, and she was extubated. On Day 18, her antibiotic treatment was completed.

CONCLUSIONS: We describe a patient with invasive GAS infections whose initial manifestation was typical of erysipelas, but she eventually required intubation due to complicated epiglottitis. Even when GAS disease is treated with antibiotics, it may be difficult to prevent subsequent invasive GAS disease. Regardless of the initial diagnosis and treatment, careful monitoring is vital. When invasive GAS infection is suspected, there is a need to prepare for urgent intervention.

Keywords: Epiglottitis, Erysipelas, Streptococcus pyogenes