title: Severe group A streptococcal toxic shock syndrome presenting as primary peritonitis: a case report and brief review of the literature.
abstract: Streptococcal toxic shock syndrome (STSS) can be defined as a septic shock syndrome resulting from infection with toxin-producing group A streptococci (GAS). STSS can sporadically present as primary peritonitis in previously healthy persons. Signs of STSS are non-specific and patients generally present with flu-like symptoms and can develop a life-threatening toxic shock syndrome in just a few hours. Diagnosis is mainly by a combination of physical examination, laboratory/culture results, and exclusion of surgical causes by means of imaging modalities and/or surgical exploration. GAS remain penicillin-sensitive and most are clindamycin-sensitive. Prompt supportive treatment, possibly together with high-dose intravenous immunoglobulins, is crucial.
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands. alwintilanus@hotmail.com
authors.forename: A M R
authors.initials: AM
authors.lastname: Tilanus
authors.forename: H R H
authors.initials: HR
authors.lastname: de Geus
authors.forename: B J A
authors.initials: BJ
authors.lastname: Rijnders
authors.forename: R S
authors.initials: RS
authors.lastname: Dwarkasing
authors.forename: B
authors.initials: B
authors.lastname: van der Hoven
authors.forename: J
authors.initials: J
authors.lastname: Bakker
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D010538:Peritonitis / Q000175:diagnosis*; D012772:Shock, Septic / Q000175:diagnosis* / Q000188:drug therapy; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013297:Streptococcus pyogenes
chemical_list: D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous; D010406:Penicillins; D002981:Clindamycin