Severe group A streptococcal toxic shock syndrome presenting as primary peritonitis: a case report and brief review of the literature
Tilanus, A.M.R.; de Geus, H.R.H.; Rijnders, B.J.A.; Dwarkasing, R.S.; van der Hoven, B.; Bakker, J.
International Journal of Infectious Diseases Ijid Official Publication of the International Society for Infectious Diseases 14 Suppl. 3: E208-E212
ISSN/ISBN: 1201-9712 PMID: 19914115 DOI: 10.1016/j.ijid.2009.07.014
Streptococcal toxic shock syndrome (STSS) can be defined as a septic shock syndrome resulting from infection with toxin-producing group A streptococci (GAS). STSS can sporadically present as primary peritonitis in previously healthy persons. Signs of STSS are non-specific and patients generally present with flu-like symptoms and can develop a life-threatening toxic shock syndrome in just a few hours. Diagnosis is mainly by a combination of physical examination, laboratory/culture results, and exclusion of surgical causes by means of imaging modalities and/or surgical exploration. GAS remain penicillin-sensitive and most are clindamycin-sensitive. Prompt supportive treatment, possibly together with high-dose intravenous immunoglobulins, is crucial.