Life-threatening Streptococcus suis Sepsis Presenting with Purpura Fulminans and Toxic Shock-like Syndrome in a Patient with Unknown Exposure Route.

Streptococcus suis is a zoonotic pathogen that typically infects humans through occupational exposure to pigs or pork products. We report a life-threatening case of S. suis infection in a 56-year-old male with no clear history of swine contact. The patient presented with fever and altered mental status, rapidly developing septic shock, disseminated intravascular coagulation, and purpura fulminans. S. suis was isolated from blood cultures, and subsequent molecular analysis identified the isolate as serotype 2, sequence type 1 (ST1), belonging to clonal complex 1 (CC1). Despite intensive multimodal therapy and successful initial resuscitation, extensive necrosis of the lower extremities necessitated bilateral below-knee amputation in the chronic phase. The patient survived the septic shock and was eventually transferred to a nursing facility. Notably, this life-threatening infection occurred in a physician with no identifiable swine exposure, highlighting that S. suis can cause streptococcal toxic shock-like syndrome (STSLS) through unrecognized routes and underscoring the need for heightened clinical awareness and epidemiological surveillance. Early recognition, prompt intensive care, and definitive surgical intervention are critical for survival.