链球菌中毒性休克综合征是A组链球菌感染的严重并发症,死亡率高。快速检测,早期重症监护支持,和手术管理是至关重要的治疗这些患者。我们介绍了一个65岁的男性病例,有记录的高血压病史,2型糖尿病,和外周动脉疾病。患者在急诊科接受评估,主诉疼痛,他的左腿肿胀,和发烧。体检显示心动过速,低血压,左腿有明显的炎症迹象.经过初步的临床和实验室评估,患者被诊断为蜂窝织炎和尿路感染。他表现为多器官功能障碍进行性恶化,需要血管加压药支持,有创机械通气,和肾脏替代疗法。在血液培养物中分离出化脓性链球菌,考虑了链球菌中毒性休克综合征。适当的抗生素治疗,免疫球蛋白,血液灌流,和皮质类固醇治疗,临床改善。住院期间,皮肤病变逐渐改善.临床稳定后,患者出院并进行随访。所呈现的病例显示皮肤链球菌感染伴随多器官功能障碍的快速发展。尽管这些类型的感染具有相关的高死亡率,这个病人活了下来。使用免疫球蛋白和血液灌流技术,在这种情况下,可能促成了这一积极结果。因此,我们强调需要高度怀疑这种综合症,尤其是出现皮肤病变的糖尿病患者。一旦诊断确定,这些感染需要密切监测和快速强化治疗.
Streptococcal toxic shock syndrome is a serious complication of group A Streptococcus infection with a high mortality rate. Rapid detection, early intensive care support, and surgical management are paramount in treating these patients. We present a case of a 65-year-old male, with a documented medical history of hypertension, type 2 diabetes mellitus, and peripheral arterial disease. The patient was evaluated in the emergency department with a chief complaint of pain, swelling in his left leg, and fever. Physical examination showed tachycardia, hypotension, and clear inflammatory signs in the left leg. After initial clinical and laboratory evaluation, the patient was admitted with a diagnosis of cellulitis and urinary tract infection. He presented progressive worsening with multi-organ dysfunction, requiring vasopressor support, invasive mechanical ventilation, and renal replacement therapy. Streptococcus pyogenes was isolated in blood cultures, and a streptococcal toxic shock syndrome was considered. Appropriate antibiotic therapy, immunoglobulins, hemoperfusion, and corticosteroid therapy were administered, with clinical improvement. During hospitalization, there was a progressive improvement in the skin lesion. Once clinically stabilized the patient was discharged with follow-up. The case presented shows the rapid evolution of cutaneous streptococcal infection with multiorgan dysfunction. Although these types of infections have an associated high mortality rate, this patient survived. The use of immunoglobulin and hemoperfusion technique, in this case, might have contributed to this positive outcome. Therefore, we highlight the need for high suspicion of this syndrome, especially in diabetic patients presenting with skin lesions. Once the diagnosis is established, these infections require close surveillance and rapid and intensive treatment.