A Severe Case of Streptococcus pyogenes Pneumonia Following Influenza A Virus Infection Diagnosed by FilmArray Pneumonia Panel and Bronchoalveolar Lavage.

Abstract

A previously healthy 63-year-old woman, unvaccinated for influenza A, had a mild fever for a week followed by alerted consciousness. On the day of admission, she developed shortness of breath, high fever, hypotension and alterations of consciousness. Chest CT revealed rapidly progressing bilateral infiltrates. She was diagnosed with disseminated intravascular coagulation, hypogammaglobulinemia and acute renal failure, requiring intensive care for respiratory failure and hypotension. A Sputum FilmArray Pneumonia Panel (PN panel) performed on admission identified multiple pathogens, including influenza A virus and Streptococcus pyogenes (S. pyogenes), although only S. pyogenes was cultured from bronchoalveolar lavage fluid. Intensive care, including antibiotics and steroids, led to clinical improvement. Blood cultures remained negative throughout the course. Even healthy adults can develop severe S. pyogenes pneumonia following influenza A infection. Rapid bacterial identification by PN panel and bronchoscopy, along with an appropriate treatment strategy, may improve outcomes.