[A case report of toxic shock-like syndrome due to group A streptococcal infection in an alcoholic].
A 47-year-old male with a history of alcohol abuse had a sore throat on June 8, 1994. On June 13, he had swelling and pain on his right fore-arm. He had tense swelling, redness and pain on the right lower abdomen, left upper arm and left lower leg with high fever and noticed erythema and blisters on his back of the right hand on June 18, which gradually expanding to the entire fore-arm. He was admitted to the local hospital on July 2, where he was operated with excision of the skin and drainage for an abdominal subcutaneous abscess and was given three antibiotics and an intravenous immunoglobulin preparation. Although he showed transient hypotension and moderate liver dysfunction, his condition improved day by day under such treatment. He was transferred to our hospital on July 7 because of the unknown etiology. Aspirate from the abscess contained gram-positive cocci in chains, and group A streptococci were isolated. Panipenem/betamipron was used for an antibiotic during roughly two weeks and excision of the skin and drainage for abscess was performed twice. His skin lesions were continued to improve, normalizing peripheral white blood cell counts, serum levels of CRP and the liver function. On July 24, the antibiotic was changed to intravenous ampicillin and administered for 16 days and amoxicillin was given orally after that, and he was discharged on August 16. An isolate of the infecting Streptococcus pyogenes produced pyrogenic exotoxin A, B and the serotype was T-3 type.
Ono
Y
Y
Second Department of Internal Medicine, School of Medicine, Teikyo University.
Megumi
M
M
Sugiyama
H
H
Tokumura
Y
Y
Ohyatsu
I
I
Miyashita
T
T
Kato
J
J
Nishiya
H
H
Kunii
O
O
Miyashita
H
H
D000437:Alcoholism / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000209:etiology / Q000382:microbiology*; D013290:Streptococcal Infections; D013297:Streptococcus pyogenes