title: Toxic shock syndrome due to group A streptococcal pharyngitis and bacteremia in adults.
abstract: Bacteremia and/or toxic shock syndrome are rare complications of streptococcal pharyngitis in adults. This report describes a previously healthy young man with streptococcal toxic shock syndrome who presented with fatigue, high fever, and suspected extensive streptococcal tonsillopharyngitis. Treatment consisted of high-dose antibiotics followed by therapy for consumptive coagulopathy, acute renal failure, and toxic shock syndrome. An attempt at hemodialysis and hemodiafiltration was ineffective, and the patient died within 24 h of 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 types with pyrogenic exotoxin genes A and B. This was a definitive case of streptococcal toxic shock syndrome complicated with multiorgan failure and fatal outcome. The benefits of intravenous immunoglobulins, surgical intervention, or clindamycin for improving survival remain 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
authors.initials: I
authors.lastname: Jajic-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*; D017809:Fatal Outcome; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D010612:Pharyngitis / 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 / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents