Hohn H, Kaufhold A, Schoenemann J, Seifert H
Medizinische Abteilung, St.-Elisabeth-Krankenhauses Köln-Hohenlind.
Dtsch Med Wochenschr. 1993 Oct 1;118(39):1395-400. doi: 10.1055/s-2008-1059466.
Four days after being bitten by an insect a 35-year-old woman without any serious underlying disease developed an extensive phlegmonous inflammation of the left eyelid which soon spread to the entire left half of her face. Streptococcus pyogenes serotype M1, which produced the erythrogenic toxin A in vitro, was isolated from two blood cultures. The course of the illness was characterized by high fever, diarrhoea, vomiting, circulatory failure, consumption coagulopathy, abnormal renal functions and a generalized exanthem with desquamation of the skin, exhibiting the full-blown picture of a toxic shock syndrome caused by S. pyogenes. She eventually recovered completely under intensive care involving administration of catecholamines, fresh frozen plasma and antithrombin III substitution, as well as antibiotic treatment with clindamycin (600 mg three times daily), ampicillin/sulbactam (4 g three times daily)--after 3 days replaced by imipenem (0.5 g four times daily)--and gentamycin (80 mg three times daily) for two weeks. Extensive necroses later required plastic surgery to the left eyelid, cheek and temporal region.
一名35岁无严重基础疾病的女性被昆虫叮咬4天后，左侧眼睑出现广泛的蜂窝织炎，很快蔓延至左侧整个面部。从两份血培养物中分离出了化脓性链球菌M1血清型，该菌株在体外产生致热外毒素A。疾病过程的特征为高热、腹泻、呕吐、循环衰竭、消耗性凝血病、肾功能异常以及全身性皮疹伴皮肤脱屑，呈现出由化脓性链球菌引起的中毒性休克综合征的典型症状。她最终在重症监护下完全康复，治疗措施包括使用儿茶酚胺、新鲜冷冻血浆和抗凝血酶III替代治疗，以及使用克林霉素（每日3次，每次600毫克）、氨苄西林/舒巴坦（每日3次，每次4克）——3天后换用亚胺培南（每日4次，每次0.5克）——和庆大霉素（每日3次，每次80毫克）进行为期两周的抗生素治疗。后期广泛的坏死需要对左侧眼睑、脸颊和颞部进行整形手术。
