title: Group A streptococcal toxic shock syndrome with severe necrotizing fasciitis following hysterectomy--a case report.
abstract: In the last 10 years an increasing number of cases of group A streptococcal toxic shock syndrome have appeared in various clinical settings. The manifestation of this syndrome includes rapidly progressive multiorgan failure and soft-tissue necrosis. This report presents a case of streptococcal toxic shock syndrome caused by Streptococcus pyogenes with severe necrotizing fasciitis of the abdominal wall following hysterectomy. Aggressive surgical intervention with debridement of all necrotic tissue necessitated resection of the complete abdominal wall (skin, subcutaneous tissue, muscle and peritoneum). The abdominal wall defect was covered with free myocutaneous flaps and split-skin grafts. Optimal treatment, including adequate antibiotic therapy and radical surgical intervention, is an indispensable prerequisite of successful outcome.
authors.affiliation: Institut für Anästhesiologie, Ludwig-Maximilians-Universität Klinikum Grosshadern, München, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Loscar
authors.forename: G
authors.initials: G
authors.lastname: Schelling
authors.forename: M
authors.initials: M
authors.lastname: Haller
authors.forename: J
authors.initials: J
authors.lastname: Polasek
authors.forename: C
authors.initials: C
authors.lastname: Stoll
authors.forename: U
authors.initials: U
authors.lastname: Kreimeier
authors.forename: U
authors.initials: U
authors.lastname: Finsterer
authors.forename: H O
authors.initials: HO
authors.lastname: Steitz
authors.forename: R
authors.initials: R
authors.lastname: Baumeister
authors.forename: R
authors.initials: R
authors.lastname: Kimmig
authors.forename: B
authors.initials: B
authors.lastname: Grabein
authors.forename: J
authors.initials: J
authors.lastname: Briegel
mesh_terms: D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000382:microbiology* / Q000628:therapy; D012772:Shock, Septic / Q000209:etiology* / Q000382:microbiology / Q000628:therapy