Two Cases of Toxic Shock-like Syndrome due to Group A Streptococcus.

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  • 劇症型Ａ群連鎖球菌感染症の２例

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We report two cases of toxic shock-like syndrome. Case 1: A 43-year-old healthy woman developed a painful swelling on the right leg, right foot, and then both hands a few days after contusion of her right ankle, which evolved into necrosis of skin which reached the deep fascia. Shock ensued, and laboratory examinations showed leukocytosis, increased serum levels of anti-streptolysin O, C-reactive protein (CRP), creatine phosphokinase (CK) and myoglobin, and both liver and kidney dysfunction. A culture of a skin lesion yielded group A β-hemolytic streptococci. Antibiotics and dopamine therapy in combination with continuous hemodiafiltration were effective. Case 2: A 67-year-old woman receiving corticosteroid therapy for dermatomyositis developed a painful swelling on her right knee after twisting it. Two days later, shock abruptly occurred, and laboratory examinations showed increased serum levels of CRP and CK and renal dysfunction. A culture of aspirate from the right knee joint yielded group A β-hemolytic streptococi. She died on the same day. An early diagnosis and prompt treatment of toxic shock-like syndrome are essential for improving the outcome. Dermatologists should keep in mind that a common skin manifestation of this syndrome is necrotizing fasciitis.

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