title: Toxic shock syndrome due to group A streptococcal pharyngitis and bacteremia in an adult.
abstract: Bacteremia and/or toxic shock syndrome is a rare complication of streptococcal pharyngitis in adults. We describe a case of streptococcal toxic shock syndrome in a previously healthy young man who presented with fatigue, high fever, and suspected extensive streptococcal tonsillo-pharyngitis. Therapy consisted of high doses of antibiotics followed by treatment of consumptive coagulopathy, acute renal failure, and toxic shock syndrome. An attempt at hemodialysis and hemodiafiltration was ineffective, and the patient died 24 h after admission. The autopsy findings were compatible with the clinical diagnosis. The invasive group A streptococci isolated from the pharyngeal swab and blood cultures were identified as M1 and T1 type with pyrogenic exotoxin genes A and B. This was thus a definite case of streptococcal toxic shock syndrome complicated with multiorgan failure and lethal outcome. The benefit of intravenous immunoglobulins, surgical intervention, or clindamycin in survival improvement remains to be evaluated.
authors.affiliation: Department of Emergency Medicine, University Department of Medicine, Sestre milosrdnice University Hospital, Zagreb, Croatia. zeljko.vucicevic@zg.t-com.hr
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Vucicevic
authors.forename: Ines Jajic
authors.initials: IJ
authors.lastname: Bencic
authors.forename: Bozo
authors.initials: B
authors.lastname: Kruslin
authors.forename: Vesna
authors.initials: V
authors.lastname: Degoricija
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D001426:Bacterial Proteins / Q000235:genetics; D002981:Clindamycin / Q000627:therapeutic use; D005098:Exotoxins / Q000235:genetics; D017809:Fatal Outcome; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D008565:Membrane Proteins / Q000235:genetics; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000235:genetics / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D005098:Exotoxins; D008565:Membrane Proteins; C117980:SpeA protein, Streptococcus pyogenes; C027951:erythrogenic toxin; D002981:Clindamycin