Domislović Viktor, Sremac Maja, Kosuta Iva, Sesa Vibor, Jovic Andrijana, Grsic Kresimir, Papic Neven, Mrzljak Anna
Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia.
Department of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia.
World J Clin Cases. 2025 Aug 26;13(24):106827. doi: 10.12998/wjcc.v13.i24.106827.
Streptococcal toxic shock syndrome (STSS), caused by group A Streptococcus (), is characterized by shock and multiorgan failure and is associated with a high mortality rate. Organ transplant recipients are especially vulnerable due to immunosuppressive therapy. Although critical for graft survival, immunosuppression increases susceptibility to infections, the leading cause of morbidity and mortality early after liver transplantation.
A 69-year-old female on dual immunosuppressive regimen with mycophenolate mofetil and tacrolimus due to liver transplantation in 2010 and chronic kidney disease presented to the emergency department after tripping at home and injuring her neck with a wooden splinter from a chair. She developed progressive neck swelling and erythema with a diffuse maculopapular rash. Contrast-enhanced computed tomography scan showed a multiloculated neck abscess (59 mm × 32 mm × 85 mm). Her leucocyte count was 22.4 × 10/L, C-reactive protein 327.4 mg/L, and creatinine 233 μmol/L. Microbiological analysis tested positive for group A Streptococcus, suggesting diagnosis of STSS. She developed hypotension, dyspnea and fever prompting an urgent surgical drainage. Mycophenolate mofetil was discontinued, tacrolimus was reduced and was treated with cephazolin and clindamycin. Her skin rash slowly resolved, C-reactive protein decreased to 53.0 mg/L and kidney function improved. A computed tomography scan confirmed resolution and showed no new abscess formation. After two years of follow-up, she is unremarkable.
STSS in organ transplant recipients demands rapid managing of infections while minimizing the risk of graft rejection.
由A组链球菌引起的链球菌中毒性休克综合征（STSS），其特征为休克和多器官功能衰竭，死亡率很高。器官移植受者由于免疫抑制治疗而特别易患该病。免疫抑制虽然对移植物存活至关重要，但会增加感染易感性，而感染是肝移植后早期发病和死亡的主要原因。
一名69岁女性，因2010年肝移植及慢性肾病接受霉酚酸酯和他克莫司双重免疫抑制治疗。在家中绊倒后，被椅子上的木片划伤颈部，随后前往急诊科就诊。她出现颈部逐渐肿胀、红斑，并伴有弥漫性斑丘疹。增强计算机断层扫描显示颈部有一个多房性脓肿（59毫米×32毫米×85毫米）。她的白细胞计数为22.4×10⁹/L，C反应蛋白为327.4毫克/升，肌酐为233微摩尔/升。微生物分析检测A组链球菌呈阳性，提示诊断为STSS。她出现低血压、呼吸困难和发热，促使紧急进行手术引流。停用霉酚酸酯，减少他克莫司剂量，并给予头孢唑林和克林霉素治疗。她的皮疹逐渐消退，C反应蛋白降至53.0毫克/升，肾功能改善。计算机断层扫描证实脓肿已消退，未发现新的脓肿形成。经过两年随访，她情况良好。
器官移植受者发生STSS时，需要迅速控制感染，同时将移植物排斥风险降至最低。
