title: Toxic shock-like syndrome.
abstract: Invasive group A streptococcal infection has important diagnostic and therapeutic implications in patients with necrotizing fasciitis. We cared for a man with the full-blown syndrome in whom many features of toxic shock syndrome were present, including profound hypotension and renal failure. The diagnostic similarities of toxic shock syndrome and the toxic shock-like syndrome caused by group A Streptococcus could have led to inappropriate treatment. Successful therapy in our patient included high doses initially of broad-spectrum antibiotics, repeated operative debridement of the lower leg (the affected limb), and ultimately, reconstructive surgery consisting primarily of split-thickness skin grafts. The reemergence of invasive streptococcal infections may relate to changes either in virulence factors of the causative streptococcus or in exotoxins elaborated by this microorganism. A causative relationship between an exotoxin produced by group A Streptococcus and the toxic shock-like syndrome has not yet been established.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Arizona, Tucson 85721.
authors.forename: B L
authors.initials: BL
authors.lastname: Erstad
authors.forename: C L
authors.initials: CL
authors.lastname: Witte
authors.forename: D F
authors.initials: DF
authors.lastname: Talkington
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D003937:Diagnosis, Differential; D005208:Fasciitis / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery / Q000628:therapy; D006801:Humans; D007866:Leg / Q000473:pathology; D008297:Male; D009336:Necrosis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery / Q000628:therapy; D012772:Shock, Septic / Q000175:diagnosis* / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents