Toxic shock syndrome due to group A streptococcal pharyngitis and bacteremia in an adult

Bacteremia and/or toxic shock syndrome is a rare complication of streptococcal pharyngitis in adults. We describe a case of streptoccocal toxic shock syndrome in a previously healthy young man who presented with fatigue, high fever, and suspected extensive streptoccocal tonsillo-pharyngitis. Therapy consisted of high doses of antibiotics followed by treatment of consumptive coagulopathy, acute renal failure, and toxic shock syndrome. An attempt at hemodialysis and hemodiafiltration was ineffective, and the patient died 24 h after admission. The autopsy findings were compatible with the clinical diagnosis. The invasive group A streptococci isolated from the pharyngeal swab and blood cultures were identified as M1 and T1 type with pyrogenic exotoxin genes A and B. This was thus a definite case of streptococcal toxic shock syndrome complicated with multiorgan failure and lethal outcome. The benefit of intravenous immunoglobulins, surgical intervention, or clindamycin in survival improvement remains to be evaluated.