title: Septic pulmonary thrombosis in streptococcal toxic shock syndrome.
abstract: A 60-year-old woman who was previously in good health presented with a sore throat, fever, and a flu-like syndrome. Treated initially with acetaminophen and fluids for a presumed viral infection, she had a syncopal episode 4 days later, was admitted to the hospital, and died 3 hours after admission. Laboratory test results suggested sepsis with disseminated intravascular coagulation (DIC), whereas blood cultures grew group A beta-hemolytic streptococci. A postmortem diagnosis of streptococcal toxic shock syndrome was established. It was of particular interest that the pulmonary microcirculation was filled with thrombi that contained numerous gram-positive cocci. Although death from sepsis with DIC is not uncommon, septic pulmonary thrombosis has not been previously described. We speculate that this paradox may reflect unique properties of the virulent strains of Streptococcus pyogenes that are associated with streptococcal toxic shock syndrome.
authors.affiliation: Department of Pathology, Rochester General Hospital, University of Rochester School of Medicine, NY 14621, USA.
authors.forename: S F
authors.initials: SF
authors.lastname: Cramer
authors.forename: Z M
authors.initials: ZM
authors.lastname: Tomkiewicz
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000473:pathology*; D012772:Shock, Septic / Q000150:complications / Q000473:pathology*; D013290:Streptococcal Infections / Q000150:complications / Q000473:pathology*