A Case of Streptococcal Toxic Shock Syndrome with Myonecrosis / 감염

ABSTRACT

Invasive infections by group A streptococci have reemerged as a global public health problem since the middle of the 1980s. Streptococcal toxic shock syndrome (StrepTSS) is one manifestation of invasive streptococcal infections, and it is characterized by necrotic infection of soft tissue. Myonecrosis can occur in StrepTSS, but the clinical features of this subset of StrepTSS are not clearly defined. A previously healthy 38-year-old woman was hospitalized because of pain and edema of both legs, which had developed one day prior to admission. Six hours after admission, the swelling of the patient's left leg became more severe and areas of well-demarcated violescent discoloration of the skin and hemorrhagic bullae developed. A further ten hours later, she was in shock and exhibited signs of disseminated intravascular coagulation and multiple organ failure. Gram stain of an aspirate from the bulla revealed short chains of gram-positive cocci. Streptococcus pyogenes was isolated from blood culture and the presence of streptococcal exotoxins (speA gene) and M-protein type 3 were confirmed using the polymerase chain reaction. Muscle biopsy showed extensive myonecrosis and hemorrhage without infiltration of leukocytes. Despite intensive treatment with antibiotics (including clindamycin), debridement, and intravenous gamma globulin, the patient died four days after admission to the hospital.