title: Streptococcal toxic shock syndrome and sepsis manifesting in a patient with chronic rheumatoid arthritis.
abstract: Streptococcal-toxic-shock syndrome is caused by virulent strains of exotoxin-producing streptococcus, almost always group-A organisms such as Streptococcus pyogenes. It has often been described in the setting of surgical wounds, burns, childbirth, diabetics, elderly, neonates, and immunocompromised hosts, where the portal of entry is the skin. Our patient was on steroids and nonsteroidal anti-inflammatory drugs for chronic rheumatoid arthritis and developed this deadly infection after a fall.
authors.affiliation: Department of Pathology, University of Texas Health Science Center at San Antonio, USA. chikkamuniya@uthscsa.edu
authors.forename: Shylashree
authors.initials: S
authors.lastname: Chikkamuniyappa
mesh_terms: D000058:Accidental Falls; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001132:Arm / Q000601:surgery; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D002481:Cellulitis / Q000175:diagnosis; D003131:Combined Modality Therapy; D003646:Debridement; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000209:etiology*; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D016867:Immunocompromised Host; D007555:Isoxazoles / Q000627:therapeutic use; D000077339:Leflunomide; D008297:Male; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D013206:Staphylococcal Scalded Skin Syndrome / Q000175:diagnosis; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D000092464:Elbow Injuries
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D018501:Antirheumatic Agents; D007555:Isoxazoles; D006886:Hydroxychloroquine; D000077339:Leflunomide