Abstract
Streptococcal toxic shock syndrome (STSS) is attributed to “flesh-eating bacteria” because of its rapid progression and high mortality rates. Survivors often require amputation of the affected limbs. Here we report a case of widespread STSS that affected almost of all left lower limb and retroperitneum and that treated successfully with aggressive debridement and supportive care without amputation. A 41-year-old woman arrived at our emergency room in shock. Acute fulminant soft-tissue infection was diagnosed, and treatment was initiated to combat septic shock; we later diagnosed STSS according to the gram-positive bacteria isolated from a blister. Infection had spread throughout the ankle to the level of iliopsoas. Surgery was performed immediately. Because muscle tissue was unaffected, only necrosing tissue was debrided, and the retroperitoneum was left open until no necrotic tissue needed to be debrided. Postoperatively, the wound was monitored daily, with additional intensive care and debridement to ensure excision of all necrotic tissue and salvage of the limb. The current case indicates that prompt diagnosis and aggressive debridement can achieve a favorable outcome, including preservation of limb function, even in case of wide spread cutaneous STSS.
