Recurrent Streptococcus agalactiae Toxic Shock Syndrome Triggered by a Tumor Necrosis Factor-α Inhibitor.
Streptococcal toxic shock syndrome caused by group B streptococcus (GBS) is a rare, but lethal disease. We experienced a 45-year-old woman with pustular psoriasis who developed toxic shock-like syndrome during infliximab treatment. Surprisingly, similar episodes recurred three times in one year with restarting of infliximab treatments. In the third episode, GBS were detected in blood, urine, and vaginal secretion cultures. These episodes of shock syndrome were possibly due to GBS. To the best of our knowledge, this is the first case report of recurrent streptococcal toxic shock syndrome possibly caused by GBS which was induced by anti-TNF-α inhibitor therapy. The restarting of biological agents in patients with a history of toxic shock syndrome should therefore be avoided as much as possible.
The Second Department of Internal Medicine, Nagasaki University Hospital, Japan.
Masataka
M
Yoshida
Takahiro
T
Takazono
Masato
M
Tashiro
Tomomi
T
Saijo
Yoshitomo
Y
Morinaga
Kazuko
K
Yamamoto
Shigeki
S
Nakamura
Yoshifumi
Y
Imamura
Taiga
T
Miyazaki
Toyomitsu
T
Sawai
Tomoya
T
Nishino
Koichi
K
Izumikawa
Katsunori
K
Yanagihara
Hiroshi
H
Mukae
Shigeru
S
Kohno
D003879:Dermatologic Agents / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects*; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy; D012008:Recurrence; D012772:Shock, Septic / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D013292:Streptococcus agalactiae / Q000302:isolation & purification*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab