title: Streptococcal toxic shock syndrome after breast reconstruction.
abstract: Streptococcal toxic shock syndrome (STSS) is an increasingly common disease entity but has rarely been described in the plastic surgery literature. We present the first known case of STSS associated with a reconstructive procedure. Two weeks postoperatively from a transverse rectus abdominis musculocutaneous flap for breast reconstruction, our patient presented with flulike symptoms and progressed rapidly to multiorgan failure. Though initially no nidus for infection was evident, the abdominal donor site was surgically debrided and found to contain group A Streptococcus. Following aggressive rehydration and antibiotic therapy, the patient gradually made a full recovery. In this case report, we review the presentation and epidemiology of STSS and compare it to the more common staphylococcal toxic shock syndrome. In addition, we discuss the management and outcomes of STSS, with an emphasis on raising clinical suspicion for this rare but dangerous entity.
authors.affiliation: Section of Plastic Surgery, University of Michigan, Ann Arbor, MI , USA.
authors.forename: Ashley N
authors.initials: AN
authors.lastname: Agerson
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D003646:Debridement; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D017568:Rectus Abdominis / Q000601:surgery; D012772:Shock, Septic / Q000209:etiology* / Q000628:therapy; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D013297:Streptococcus pyogenes; D013524:Surgical Flaps / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents