Fulminant Streptococcal Toxic Shock Syndrome

Abstract

We present a case of a previously healthy 37-year-old male who developed fever, nausea, vomiting, diarrhoea, and hypovolaemia. Within 5.5 h he presented with tachycardia, tachypnoea, became hypotensive and displayed a diffuse erythematous rash. In the following hours he developed persistent hypotension, acute respiratory distress syndrome, liver failure, kidney failure and disseminated intravascular coagulation. A diagnosis of toxic shock syndrome was made, but despite antibiotic therapy, immunoglobulin administration, and supportive measures, the patient died 50 h after presentation. Streptococcus pyogenes was isolated from blood cultures.

Acute Liver Failure

“…Bacterial infections induce systemic inflammation that may result in organ failure and ACLF through complex mechanisms leading to a high risk of short-term mortality; 113 infection is one of the most fatal complications in ALF, particularly when accompanied by multiorgan failure, with a reported incidence of up to 90%; 28,54 liver failure complicating sepsis/septic shock has an important impact on mortality in ICU patients; 114 and streptococcal toxic shock syndrome is complicated with acute liver and renal failure, ARDS, and disseminated intravascular coagulation. 115 Functional monocyte damage and consequent immune paresis contribute to increased susceptibility for infections in ALF. 9,116 The most common infections include pneumonia, urinary tract infection, and catheter-associated bloodstream infection.…”