Bomke A-K, Vagts D A, Podbielski A
Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Abteilung Medizinische Mikrobiologie und Krankenhaushygiene, Universität Rostock.
Dtsch Med Wochenschr. 2006 Feb 10;131(6):263-6. doi: 10.1055/s-2006-924959.
A 41-year-old, obese man with a history of incomplete paraplegia of both legs and chronic venous insufficiency with stasis dermatitis presented with acute respiratory and hyperdynamic hemodynamic failure. He was transferred from another hospital to the department of intensive care medicine for further diagnosis and treatment. A livid coloured, necrotizing-hemorrhagic swelling of the right lower leg was noted.
Laboratory tests revealed an inflammation probably due to bacterial infection, anemia, acute renal failure, acute hepatic dysfunction, coagulopathy and lactic acidosis, indicating multi-organ failure and septic shock. No focus of sepsis was found at abdominal sonography and exploratory laparotomy. Chest X-Ray and computed tomography revealed bilateral pneumonia. Doppler ultrasonography of both legs showed acute isolated thrombosis of the right posterior tibial vein.
In addition to a chronic venous ulcer-necrotizing hemorrhagic erysipelas had developed in the right lower leg. A swab taken at surgery and blood cultures grew Streptococcus dysgalactiae ssp. equisimilis (group G streptococci, GGS). Despite intensive care treatment and high dosage penicillin G therapy the patient died two days after admission from septic shock and multi-organ failure.
Group G streptococci cause a variety of common and severe infections. Erysipelas is infrequently associated with GGS but, much more often, with group A streptococci (GAS). This unusual and fulminant case emphasizes the importance of considering Streptococcus dysgalactiae as a causative agent in septicemia with multiple predisposing factors and soft-tissue infections.
一名41岁的肥胖男性，有双腿不完全截瘫病史及慢性静脉功能不全伴淤积性皮炎，现出现急性呼吸和高动力血流动力学衰竭。他从另一家医院转入重症医学科进一步诊断和治疗。右小腿可见青紫色、坏死性出血性肿胀。
实验室检查显示可能因细菌感染引起炎症、贫血、急性肾衰竭、急性肝功能障碍、凝血病和乳酸酸中毒，提示多器官功能衰竭和感染性休克。腹部超声和剖腹探查未发现败血症病灶。胸部X线和计算机断层扫描显示双侧肺炎。双腿多普勒超声显示右胫后静脉急性孤立性血栓形成。
除慢性静脉溃疡外，右小腿还发生了坏死性出血性丹毒。手术拭子及血培养培养出马链球菌兽疫亚种（G组链球菌，GGS）。尽管给予了重症监护治疗及大剂量青霉素G治疗，但患者入院两天后死于感染性休克和多器官功能衰竭。
G组链球菌可引起多种常见和严重感染。丹毒很少与GGS相关，而更常与A组链球菌（GAS）相关。这一罕见且暴发性的病例强调了在伴有多种易感因素的败血症和软组织感染中，将马链球菌视为病原体的重要性。
