[Puerperal sepsis caused by streptococcus group A with a severe form of progression like "toxic shock-like syndrome"].
METHODS
A previously healthy 32-year-old woman was admitted with shock symptoms 5 days after an uneventful home delivery. She developed a fever up to 39.5 degrees C during the days after delivery with sore throat, diarrhoea and muscle aches in all limbs. On physical examination there were swellings of the arms and lower legs as well as macular and vesicular erythrodermia, especially of the trunk.


METHODS
Abnormal laboratory findings were thrombocytopenia (20,000/microliters), increased serum concentrations of fibrin breakdown products (102 mg/dl) and of C-reactive protein (> 200 mg/dl), increased creatine kinase (5700 U/l), transaminases (GOT 220 U/l, GPT 52 U/l), creatinine (2.0 mg/dl) and urea (114 mg/dl). Streptococcus pyogenes was grown on blood culture and from vaginal smear. Sonography, echocardiography and radiological examinations failed to demonstrate a septic focus.


METHODS
Mechanical ventilation was required for 7 days because of respiratory failure and shock symptoms (toxic shock-like syndrome, TSLS). Penicillin G and tobramycin were given after the bacteriological diagnosis. Severe consumption coagulopathy was successfully treated with antithrombin III and platelet concentrates. After extubation she was found to have a flaccid tetraparesis, especially of the right and of the legs, due to soft-tissue necrosis and damage to peripheral nerves. An embolic occlusion of the right brachial artery 4 weeks after onset of the disease required upper-arm amputation.


CONCLUSIONS
One of the decisive factors for the prognosis of TSLS is early antibiotic treatment. The prodromal symptoms in this case underline the necessity of early recognition and treatment to prevent a full-blown picture of the syndrome.
Susset
M A
MA
Medizinische Klinik, Kreiskrankenhaus Reutlingen.
Sczepanski
B
B
Herrmann
M
M
Hust
M H
MH
Braun
B
B
Heizmann
W R
WR
D000328:Adult; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000990:Antithrombin III / Q000627:therapeutic use; D001132:Arm / Q000473:pathology / Q000601:surgery; D016470:Bacteremia / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D001916:Brachial Artery; D004617:Embolism / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D009336:Necrosis; D010400:Penicillin G / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D010525:Peripheral Nerves / Q000473:pathology / Q000503:physiopathology; D017713:Platelet Transfusion; D011645:Puerperal Infection / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D011782:Quadriplegia / Q000209:etiology; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012772:Shock, Septic / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D013290:Streptococcal Infections / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification / Q000472:pathogenicity*; D014031:Tobramycin / Q000627:therapeutic use; D014621:Vagina / Q000382:microbiology
D000900:Anti-Bacterial Agents; D010406:Penicillins; D000990:Antithrombin III; D010400:Penicillin G; D014031:Tobramycin
Puerperalsepis durch Streptokokken der Gruppe A mit schwerer Verlaufsform als "Toxic Shock-like Syndrome".