Silva José Miguel, Gomes Cochicho Joana, Carvalho Eduardo, Parente Ana Rita, Cruz Nodarse Armando, Pádua Fernando
Internal Medicine, Hospital Doutor José Maria Grande, Portalegre, PRT.
Intensive Care Unit, Hospital Doutor José Maria Grande, Portalegre, PRT.
Cureus. 2022 Dec 14;14(12):e32539. doi: 10.7759/cureus.32539. eCollection 2022 Dec.
Streptococcal toxic shock syndrome is a serious complication of group A infection with a high mortality rate. Rapid detection, early intensive care support, and surgical management are paramount in treating these patients. We present a case of a 65-year-old male, with a documented medical history of hypertension, type 2 diabetes mellitus, and peripheral arterial disease. The patient was evaluated in the emergency department with a chief complaint of pain, swelling in his left leg, and fever. Physical examination showed tachycardia, hypotension, and clear inflammatory signs in the left leg. After initial clinical and laboratory evaluation, the patient was admitted with a diagnosis of cellulitis and urinary tract infection. He presented progressive worsening with multi-organ dysfunction, requiring vasopressor support, invasive mechanical ventilation, and renal replacement therapy. was isolated in blood cultures, and a streptococcal toxic shock syndrome was considered. Appropriate antibiotic therapy, immunoglobulins, hemoperfusion, and corticosteroid therapy were administered, with clinical improvement. During hospitalization, there was a progressive improvement in the skin lesion. Once clinically stabilized the patient was discharged with follow-up. The case presented shows the rapid evolution of cutaneous streptococcal infection with multiorgan dysfunction. Although these types of infections have an associated high mortality rate, this patient survived. The use of immunoglobulin and hemoperfusion technique, in this case, might have contributed to this positive outcome. Therefore, we highlight the need for high suspicion of this syndrome, especially in diabetic patients presenting with skin lesions. Once the diagnosis is established, these infections require close surveillance and rapid and intensive treatment.
链球菌中毒性休克综合征是A组感染的一种严重并发症，死亡率很高。快速检测、早期重症监护支持和手术治疗对这些患者的治疗至关重要。我们报告一例65岁男性病例，其有高血压、2型糖尿病和外周动脉疾病的病史记录。该患者在急诊科接受评估，主诉为左腿疼痛、肿胀和发热。体格检查显示心动过速、低血压，左腿有明显炎症体征。经过初步临床和实验室评估，患者以蜂窝织炎和尿路感染的诊断入院。他出现多器官功能障碍并逐渐恶化，需要血管活性药物支持、有创机械通气和肾脏替代治疗。血培养分离出[具体细菌名称未给出]，考虑为链球菌中毒性休克综合征。给予了适当的抗生素治疗、免疫球蛋白、血液灌流和糖皮质激素治疗，临床症状有所改善。住院期间，皮肤病变逐渐好转。患者临床病情稳定后出院并安排了随访。该病例显示了皮肤链球菌感染伴多器官功能障碍的快速进展。尽管这类感染有较高的死亡率，但该患者存活下来。在本病例中，免疫球蛋白和血液灌流技术的使用可能促成了这一良好结果。因此，我们强调对此综合征要有高度怀疑，尤其是在有皮肤病变的糖尿病患者中。一旦确诊，这些感染需要密切监测并进行快速、强化治疗。
