Streptococcal toxic shock-like syndrome (TSLS)

Abstract

Toxic shock syndrome (TSS) is a rare, toxin-mediated acute life-threatening illness, usually precipitated by infection with either Staphylococcus aureus or group A Streptococcus (GAS), also called Streptococcus pyogenes. We present a case of 37-year-old male immunocompetent Caucasian who was hospitalized at the Clinic for Infectious Diseases because of diarrhea and vomiting with no signs of systemic infection. The symptoms disappeared after parenteral rehydration. Two days after the short lived improvement, the patient was highly febrile (40°C) with subicteric and petechial skin changes. Rapidly, respiratory, renal as well as psychical failure was observed with tachypnea, oliguria and finally anuria. Blood studies revealed inflammatory response and the indicators of hepatic and renal failure were high. Blood culture was positive on Streptococcus pyogenes. Although therapy procedures were initiated, acute respiratory distress syndrome had developed and the patient was intubated at Intensive Care Unit. Roentgenogram of the chest showed metastasis of infection, pleural effusion, and heart enlargement. The ECG showed changes characteristic of pericardial effusion as well as septal fibrosis. Splenomegaly was confirmed with computed tomography. After four weeks of treatment and further monitoring the patient was discharged from hospital in good general condition, stable vital functions and normal findings on physical systems. This was the first case of toxic shock-like syndrome described in the Department for Infectious Diseases of Clinical Center in Kragujevac.