A case of successful management of severe perinatal group A streptococcal toxic shock syndrome and thrombotic microangiopathy

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  • Yamane Kochi
    Department of Anesthesia and Intensive Care Medicine, Yokkaichi Municipal Hospital
  • Aoyama Tadashi
    Department of Anesthesia and Intensive Care Medicine, Yokkaichi Municipal Hospital
  • Momohara Hironori
    Department of Anesthesia and Intensive Care Medicine, Yokkaichi Municipal Hospital
  • Enomoto Naosuke
    Department of Obsterics and Gynecology, Yokkaichi Municipal Hospital
  • Hattori Akiko
    Department of Nephrology, Yokkaichi Municipal Hospital
  • Nonogaki Mikio
    Department of Anesthesia and Intensive Care Medicine, Yokkaichi Municipal Hospital
  • Takeichi Hiromu
    Department of Surgical Intensive Care Medicine, Nagoya University Hospital
  • Adachi Yushi
    Department of Surgical Intensive Care Medicine, Nagoya University Hospital

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  • 劇症型溶連菌感染症「劇症分娩型」に血栓性微小血管症の合併が疑われたが救命し得た一例

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<p>A 40-year-old pregnant woman presented to our hospital with sudden onset of high-grade fever and severe abdominal pain. Her clinical course suggested haemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome or placental abruption, and she underwent an emergency cesarean section. The patient’s recent medical history along with intraoperative findings suggested progressive perinatal group A streptococcal toxic shock syndrome (STSS). Empiric antimicrobial therapy, using ampicillin and clindamycin, was initiated while the surgery was still under way. She developed hemolytic anemia, acute kidney injury (AKI), and signs of concomitant thrombotic microangiopathy (TMA). Plasma exchange (PE) was initiated in the ICU. She was transferred to the ward on hospital day 7, and was discharged without any complications on hospital day 25. Immediate commencement of empiric antimicrobial therapy and intensive care management, including PE and renal replacement therapy, can help in recovering from severe STSS-induced illness.</p>

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