Case Studies

 Case 2.5 Streptococcal toxic shock syndrome

A 35-year-old man was admitted to hospital with a 7-day history of high fever, sore throat and a diffuse erythematous rash over the anterior chest wall. Additional findings on examination included hypotension (blood pressure 80/50mmHg), conjunctival injection and cellulitis of both calves. Over the next 24h there was increasing pain and swelling of the right calf associated with disappearance of the pedal pulse, necessitating emergency fasciotomies of the anterolateral and posterior compartments of the right leg. At operation, there was marked bulging of muscle in both compartments. Gram stain of the fluid obtained during fasciotomy showed Gram-positive cocci with an abundant growth of Group A beta-haemolytic streptococci on muscle culture. The same organism was also isolated from throat and blood cultures. Exotoxin typing with a gene probe revealed pyrogenic exotoxins A and B.

A diagnosis of streptococcal toxic shock syndrome was made on the basis of the above findings. The patient made a full recovery following treatment with intravenous clindamycin.