Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan; Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan.
J Infect Chemother. 2019 Dec;25(12):1037-1039. doi: 10.1016/j.jiac.2019.05.001. Epub 2019 May 29.
Streptococcal toxic shock syndrome (STSS) is a systemic, life-threatening illness usually caused by invasive respiratory tract or skin and soft tissue infections of Streptococcus pyogenes (group A streptococcus, GAS). We report the case of an adult woman with lactational amenorrhea and GAS vulvovaginitis progressing to STSS. She was admitted to our hospital because of fever, lethargy, and a 2-week history of vaginal discharge; she also had hypotension and multiple organ failure. Blood and urine cultures yielded gram-positive cocci and GAS. After 14 days of antimicrobial therapy, she fully recovered without any complications. The vulvovaginitis was most likely the portal of entry for GAS, which is rarely recognized as a causative pathogen of vulvovaginitis. Lactational amenorrhea is thought to be a risk factor for GAS vulvovaginitis. It is important for clinicians to recognize the possibility of GAS vulvovaginitis in breastfeeding women with vaginal symptoms and consider the necessity of prompt antibiotic treatment.
链球菌中毒性休克综合征（STSS）是一种全身性的、危及生命的疾病，通常由侵袭性呼吸道或皮肤和软组织的化脓性链球菌（A 组链球菌，GAS）感染引起。我们报告了一例哺乳期闭经和 GAS 外阴阴道炎进展为 STSS 的成年女性病例。她因发热、嗜睡和 2 周阴道分泌物就诊于我院，同时伴有低血压和多器官功能衰竭。血液和尿液培养出革兰阳性球菌和 GAS。经过 14 天的抗菌治疗，她完全康复，没有任何并发症。外阴阴道炎很可能是 GAS 的入口，GAS 很少被认为是外阴阴道炎的致病病原体。哺乳期闭经被认为是 GAS 外阴阴道炎的一个危险因素。对于有阴道症状的哺乳期妇女，临床医生认识到 GAS 外阴阴道炎的可能性并考虑及时进行抗生素治疗非常重要。
