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Volume 41, Number 4, August 2008

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

Zeljko Vucicevic, Ines Jajic Bencic, Bozo Kruslin, Vesna Degoricija
Department of Emergency Medicine, University Department of Medicine and Departments of Microbiology and Pathology, “Sestre milosrdnice” University Hospital, Zagreb, Croatia

Received: July 28, 2007    Revised: October 20, 2007    Accepted: January 7, 2008   


Corresponding author:

Dr. Zeljko Vucicevic, Department of Emergency Medicine, University Department of Medicine, ìSestre milosrdniceî 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 is a rare complication of streptococcal pharyngitis in adults. Wedescribe 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.


Key words:

Male; Pharyngitis; Shock, septic; Streptococcal infections; Streptococcus pyogenes



J Microbiol Immunol Infect. 2008;41:351-354.