Four cases of fulminant infection with group G hemolytic streptococcus requiring multidisciplinary therapy

Abstract

We experienced four cases of streptococcal toxic shock-like syndrome (STSS) requiring multidisciplinary therapy. All cases were middle-aged males with underlying diseases such as chronic kidney disease, liver cirrhosis, etc. Group G hemolytic streptococcus (GGS) was isolated from blood cultures. The chief complaints were high fever, disturbance of consciousness, and difficulty of movement. Although the origin of infection was unclear in one case, suppurative diseases were found in the other three cases. Blood purification with continuous renal replacement therapy was required in three cases. In two severe cases, which presented with leukopenia and thrombocytopenia, the prognosis was poor. Clinical features were consistent with past reports. In recent years, case reports describing STSS due to GGS have increased. Here this clinical entity was recognized as toxic shock-like syndrome characterized with rapid onset of sepsis and extremely poor prognosis. If we examine a middle-aged patient presenting with symptoms such as high fever, disturbance of consciousness, and difficulty of movement associated with an underlying disease, we must consider STSS due to GGS as a component of the differential diagnosis.