Invasive Group A Streptococcal Infection Following Nasal Self-Packing With Facial Tissue: A Case Report.

Invasive group A streptococcal infection (iGAS) can develop rapidly in immunocompromised individuals. We describe the case of a 66-year-old man with multiple myeloma who was admitted for chemotherapy and subsequently developed iGAS. He had been performing nasal self-packing with facial tissue for nasal discharge and hemorrhage. During hospitalization, he developed erythema, pain, and swelling around the nose and experienced a sudden onset of septic shock characterized by profound hypotension requiring norepinephrine infusion. Streptococcus pyogenes was detected in blood cultures, and treatment with beta-lactam antibiotics and clindamycin led to rapid improvement. Follow-up testing revealed that emm typing identified the strain as emm49. This case highlights that in immunocompromised individuals, trivial self-care like nasal self-packing can precipitate severe infections such as iGAS and shock, emphasizing the need for clinical vigilance.