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Volume 42, Number 3, June 2009

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

Zeljko Vucicevic, Ines Jajic-Bencic, Bozo Kruslin, Vesna Degoricija
Department of Emergency Medicine, University Department of Medicine; Department of Microbiology; and Department of Pathology, Sestre Milosrdnice University Hospital, Zagreb, Croatia

Received: July 27, 2007    Revised: January 7, 2008    Accepted: February 19, 2008   


Corresponding author:

Dr. Zeljko Vucicevic, Department of Emergency Medicine, University Department of Medicine, Sestre Milosrdnice University Hospital, Vinogradska Cesta 29, Zagreb 10000, Croatia. E-mail: Dr. Zeljko Vucicevic This e-mail address is being protected from spam bots, you need JavaScript enabled to view it



Bacteremia and/or toxic shock syndrome are rare complications of streptococcal pharyngitis in adults. This report describes a previously healthy young man with streptococcal toxic shock syndrome who presented with fatigue, high fever, and suspected extensive streptococcal tonsillopharyngitis. Treatment consisted of high-dose antibiotics followed by therapy for consumptive coagulopathy, acute renal failure, and toxic shock syndrome. An attempt at hemodialysis and hemodiafiltration was ineffective, and the patient died within 24 h of 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 types with pyrogenic exotoxin genes A and B. This was a definitive case of streptococcal toxic shock syndrome complicated with multiorgan failure and fatal outcome. The benefits of intravenous immunoglobulins, surgical intervention, or clindamycin for improving survival remain to be evaluated.


Key words:

 Pharyngitis; Shock, septic; Streptococcus pyogenes



J Microbiol Immunol Infect. 2009;42:276-279.