Early Diagnosis of Toxic Shock like Syndrome by Magnetic Resonance Imaging and Histopathology

DOI 3 Citations 13 References
  • Kubota Nobuhiko
    Department of Acute and Critical Care Medicine, Hokkaido University Hospital
  • Matsuda Naoyuki
    Department of Acute and Critical Care Medicine, Hokkaido University Hospital
  • Tikai Kanako
    Department of Surgical Pathology, Hokkaido University Hospital
  • Ito Tomoo
    Department of Surgical Pathology, Hokkaido University Hospital
  • Chiba Hitoshi
    Department of Infection Control Service, Hokkaido University Hospital
  • Kameue Takashi
    Department of Acute and Critical Care Medicine, Hokkaido University Hospital
  • Gando Satoshi
    Department of Acute and Critical Care Medicine, Hokkaido University Hospital

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Other Title
  • 劇症型Ａ群β溶連菌感染症の救命にＭＲＩと術中迅速病理診断を用いた１症例

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A 33-year-old man was admitted to our emergency room with tachycardia and hypotension. Diffuse swelling, extensive blistering were noted in the body region extending from the left thigh to the left scrotum. Laboratory data revealed severe metabolic acidosis with an elevated anion gap and high lactate level, leukocytosis and renal dysfunction. Bacteriological examination of the exudate obtained from the blisters revealed numerous Gram-positive cocci. Although computed tomography revealed only swelling of the left thigh and scrotum, MRI, which was performed when the patient was clinically stable at the previous hospital, clearly suggested extensive myofascitis of the left thigh. An emergency debridement of the infected wounds was carried out, and intraoperative histopathological diagnosis guided the area of debridment. The resected tissues from the left thigh and scrotum revealed widespread necrosis and large numbers of Gram-positive cocci, which were identified as Group A β-hemolytic streptococci. In this case report, we show that MRI and intraoperative histopathological examination are more effective than computed tomography for the early diagnosis of TSLS.

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