Cramer S F, Tomkiewicz Z M
Department of Pathology, Rochester General Hospital, University of Rochester School of Medicine, NY 14621, USA.
Hum Pathol. 1995 Oct;26(10):1157-60. doi: 10.1016/0046-8177(95)90281-3.
A 60-year-old woman who was previously in good health presented with a sore throat, fever, and a flu-like syndrome. Treated initially with acetaminophen and fluids for a presumed viral infection, she had a syncopal episode 4 days later, was admitted to the hospital, and died 3 hours after admission. Laboratory test results suggested sepsis with disseminated intravascular coagulation (DIC), whereas blood cultures grew group A beta-hemolytic streptococci. A postmortem diagnosis of streptococcal toxic shock syndrome was established. It was of particular interest that the pulmonary microcirculation was filled with thrombi that contained numerous gram-positive cocci. Although death from sepsis with DIC is not uncommon, septic pulmonary thrombosis has not been previously described. We speculate that this paradox may reflect unique properties of the virulent strains of Streptococcus pyogenes that are associated with streptococcal toxic shock syndrome.
一名60岁、既往身体健康的女性出现咽痛、发热及流感样综合征。最初因推测为病毒感染而接受对乙酰氨基酚和补液治疗，4天后她发生了一次晕厥发作，随后入院，并在入院3小时后死亡。实验室检查结果提示为脓毒症伴弥散性血管内凝血（DIC），而血培养培养出A组β溶血性链球菌。尸检诊断为链球菌中毒性休克综合征。特别值得注意的是，肺微循环中充满了含有大量革兰氏阳性球菌的血栓。虽然脓毒症伴DIC导致的死亡并不罕见，但脓毒性肺血栓形成此前尚未见报道。我们推测，这一矛盾现象可能反映了与链球菌中毒性休克综合征相关的化脓性链球菌毒力菌株的独特特性。
