Akaishi Tetsuya
Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, JPN.
Cureus. 2025 Feb 11;17(2):e78863. doi: 10.7759/cureus.78863. eCollection 2025 Feb.
Group A beta-hemolytic (GABHS) is a gram-positive type of bacteria, typically causing high fever and painful pharyngitis. The bacteria may sometimes trigger widespread skin rash in children, but systemic conditions other than sore throat are rare in adult patients with the infection. A 57-year-old woman visited our hospital with a sore throat, pruritic skin rash in the body trunk, painful oral ulcer, swollen lips, arthralgia, and swollen left wrist joint with pain. She had a recent similar clinical episode approximately four weeks before the hospital visit, which was alleviated with oral loxoprofen. The swelling of the left wrist had migrated from the left elbow area in the preceding four weeks. The patient had similar symptoms about 30 years ago, which were diagnosed with GABHS infection and successfully treated with oral antibiotics. Based on this past similar clinical episode, the patient was evaluated by the GABHS rapid antigen detection tests, which revealed a positive result. The blood test data showed normal white blood cell (WBC) count and C-reactive protein (CRP) level. She was free of any serum antibodies associated with autoimmune connective tissue diseases or syphilis. Deciding the diagnosis was difficult, but based on her past similar clinical episode in her 20s and systemic conditions resembling rheumatic fever, a diagnosis of GABHS-related uncommon systemic response was made. The patient was treated with clarithromycin (200 mg, twice a day) for 10 days and amoxicillin (250 mg, three times a day) for an additional seven days, and all symptoms resolved. Four weeks after the first hospital visit, the serum anti-streptolysin-O (ASO) level was normal at 135 IU/ml. An echocardiogram revealed an anterior mitral leaflet calcification with a mild level of mitral regurgitation. The present case indicated the importance of considering GABHS infection in adults with strong sore throat, widespread skin rash, arthralgia, and swollen joints with uncertain causes, even when the patient is afebrile with normal WBC count, CRP level, and ASO titer.
A组β溶血性（GABHS）是一种革兰氏阳性细菌，通常会引起高烧和咽喉疼痛。这种细菌有时可能会在儿童中引发广泛的皮疹，但在感染该细菌的成年患者中，除喉咙痛外出现全身症状的情况很少见。一名57岁女性因喉咙痛、躯干皮肤瘙痒性皮疹、疼痛性口腔溃疡、嘴唇肿胀、关节痛以及左手腕关节肿胀疼痛前来我院就诊。在此次就诊前约四周，她曾有过类似的临床发作，口服洛索洛芬后症状缓解。在之前的四周里，左手腕的肿胀是从左肘部区域转移过来的。该患者大约30年前曾有过类似症状，当时被诊断为GABHS感染，并通过口服抗生素成功治愈。基于过去类似的临床发作，对该患者进行了GABHS快速抗原检测，结果呈阳性。血液检测数据显示白细胞（WBC）计数和C反应蛋白（CRP）水平正常。她没有与自身免疫性结缔组织疾病或梅毒相关的血清抗体。诊断存在困难，但基于她20多岁时过去类似的临床发作以及类似风湿热的全身症状，诊断为GABHS相关的罕见全身反应。患者接受了10天的克拉霉素（200毫克，每日两次）治疗，并额外服用了7天的阿莫西林（250毫克，每日三次），所有症状均得到缓解。首次就诊四周后，血清抗链球菌溶血素O（ASO）水平正常，为135 IU/ml。超声心动图显示二尖瓣前叶钙化，伴有轻度二尖瓣反流。本病例表明，对于有严重喉咙痛、广泛皮疹、关节痛和关节肿胀且病因不明的成年患者，即使患者无发热、白细胞计数、CRP水平和ASO滴度正常，也应考虑GABHS感染的可能性。
