North Texas Research Forum 2024



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North Texas


Medical City Arlington


Internal Medicine

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toxic shock syndrome, TSS, streptococcoal infection


Bacterial Infections and Mycoses | Internal Medicine | Medicine and Health Sciences


Toxic Shock Syndrome (TSS) is a toxin induced illness characterized by fever, rash, and hypotension. TSS low incidence report and rapid onset of clinical symptoms makes getting to the diagnosis critical so that treatment can be started as soon as possible. A 65-year-old woman was brought into the emergency department (ED) after being found on the floor unresponsive during a well fair check. It was noted that she has not been seen or heard from by her family members in the last five days. She has no known past medical history and she was unresponsive and hemodynamically unstable in the ED. She was afebrile, hypotensive with a blood pressure of 88/66, tachycardia, tachypneic, and hypoxemic with an oxygen saturation of 96% while on 5 liters of nasal cannula. On physical exam, patient was noted to have a salmon pink rash with several bullae on her left lower extremity on the medial aspect of her calf starting distally from her knee and ending proximal to her ankle. Some of the bullae was intact while some had ruptured and were hemorrhagic. Another salmon pink rash was noted on her lower left extremity on the medial aspect of her thigh measuring about 3cm by 5cm. The rash was slightly raised without bullae formation. Imaging done was negative for signs of osteomyelitis. Wound debridement of the lower left extremity of the medial calf showed no signs of necrotizing infections. At this time the diagnosis of septic shock due to cellulitis was made and the patient was started on vasopressors due to her hemodynamic instability. Antibiotic treatment with vancomycin and piperacillin/tazobactam was started for broad antibiotic treatment while blood and wound cultures were pending. However, as time went on, the patients’ hemodynamic status continued to deteriorate and was sent to the intensive care unit (ICU). While in the ICU blood cultures and wound cultures came back positive for Strep pyogenes. Strep pyogenes is Group A strep that are commonly treated with penicillin. The patient current antibiotic treatment was adequate for treatment, but surgical intervention was needed for the toxic antigen released by S. pyogenes. The patient had to undergo an emergent surgical debridement of the wound, which eventually led to the patient undergoing an above the knee amputation. After the surgical intervention and treatment of antibiotic, the patient recovered and was in stable condition.

Original Publisher

HCA Healthcare Graduate Medical Education

Streptococcocal Induced Toxic Shock Syndrome: Importance of Diagnosis and Initiating Life Saving Treatment



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