title: Surviving streptococcal toxic shock syndrome: a case report.
abstract: Streptococcal toxic shock syndrome and associated myositis caused by group A beta-hemolytic streptococcus pyogenes generally have a poor outcome despite aggressive operative treatment. Frequently the diagnosis is missed initially as the clinical features are non-specific. The progression to a toxic state is rapid and unless definitive treatment measures are initiated early, the end result can be catastrophic. We report a previously healthy patient who had features of toxic shock syndrome due to alpha haemolytic (viridans) streptococcus mitis which was treated successfully with antibiotics, aggressive intensive care support including the use of a 'sepsis care bundle', monitoring and continuous multidisciplinary review. Life and limb threatening emergencies due to streptococcus mitis in an immune-competent person are rare and to our knowledge, have not previously been described in the English scientific literature. Successful outcome is possible provided a high degree of suspicion is maintained and the patient is intensively monitored.
authors.affiliation: Registrar, Department of Orthopaedics, Glan Clwyd hospital, Rhyl, UK. trmadhusudhan@gmail.com.
authors.forename: Thayur R
authors.initials: TR
authors.lastname: Madhusudhan
authors.forename: Srivatsa
authors.initials: S
authors.lastname: Sambamurthy
authors.forename: Eileen
authors.initials: E
authors.lastname: Williams
authors.forename: Ian C
authors.initials: IC
authors.lastname: Smith