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Case Reports
. 2024 Sep 11;16(9):e69220.
doi: 10.7759/cureus.69220. eCollection 2024 Sep.

Toxic Shock Syndrome: Rare but Deadly

Jorge Mendes  1 , Miguel G Santos  1 , Simone Costa  1 , Luísa Pinto  1 , Fernando Henriques  1
Affiliations
Case Reports

Toxic Shock Syndrome: Rare but Deadly

Jorge Mendes et al. Cureus. .

Abstract

Invasive group A streptococcal (GAS) disease, although rare, has a high mortality and morbidity rate, making early recognition and treatment crucial. Toxic shock syndrome (TSS) and necrotizing fasciitis are the most feared complications and require comprehensive, multidisciplinary treatment. In addition to appropriate support and resuscitation, patient management should include empirical broad-spectrum antibiotic therapy covering gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and anti-toxin therapy. Early surgical debridement is essential for improving the patient's prognosis, and other treatments, such as immunoglobulin and hyperbaric oxygen therapy (HBOT), also appear to be important. The authors describe the clinical case of a 31-year-old man with no medical history or risk factors, who developed invasive disease from Streptococcus pyogenes with rapid progression to necrotizing fasciitis, TSS, and severe multi-organ dysfunction. His management required intensive care, multiple surgical debridements, admission to the intensive care unit, and targeted as well as supportive therapy. The patient survived, but nearly a year later, he has yet to fully return to a normal life.

Keywords: emergency medicine; group a streptococcus; hyperbaric oxygen; necrotizing fasciitis; streptococcus pyogenes; toxic shock.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Patient's right leg.
The image shows the patient's right leg, displaying hemorrhagic bullae indicated by white arrows, along with marked signs of hypoperfusion and inflammation, including discoloration and edema, in the context of necrotizing fasciitis, highlighted by black arrows.
Figure 2
Figure 2. Patient's right leg.
The image shows the patient's right leg, displaying hemorrhagic bullae indicated by a white arrow, along with marked signs of hypoperfusion and inflammation, including discoloration and edema, in the context of necrotizing fasciitis, highlighted by black arrows.
Figure 3
Figure 3. CT scan of the lower limbs.
The image shows a CT scan of the lower limbs below the knee, revealing tissue infiltration with edema and a hemorrhagic bulla in the right leg. A: right leg; B: left leg; a: tibia; b: fibula; c: muscle tissue; d: extensive edema infiltrating the subcutaneous tissues; e: hemorrhagic bulla
Figure 4
Figure 4. CT scan of the lower limbs.
The image shows a CT scan of the lower limbs just above the knee, revealing marked tissue infiltration with edema, fascial thickening, and mild subcutaneous emphysema in the right leg. A: right leg; B: left leg; a: femur; b: extensive subcutaneous tissue edema extending circumferentially around the entire leg; c: mild subcutaneous emphysema; white arrows: fascial thickening
Figure 5
Figure 5. Right leg after the first surgical debridement (black arrows).
Figure 6
Figure 6. Progression in inflammatory signs to the lateral region of the right thigh requiring surgical debridement (black arrow).
Figure 7
Figure 7. Progression in inflammatory signs to the medial region of the right thigh (black arrows) with extension to the scrotum (white arrow).
Figure 8
Figure 8. Right leg showing significant improvement in inflammatory signs (white arrows), still under negative pressure treatment.
See this image and copyright information in PMC

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