Abstract
We reported a rare case of toxic shock-like syndrome (TSLS) caused by group A streptococci with soft tissue infection by group G streptococci, which demonstrated the necessity of early investigation of undiagnosed malignancy. A 41-year-old man without relevant clinical history was transferred to the ICU in a university hospital for shock-like signs, jaundice, bleeding tendency, and bulky and flushed swelling with tenderness on pudendal region. Blood culture taken before administration grew group A streptococci. Group G streptococci were also isolated from discharge of penis. Antibiotics (ampicillin, clindamycin), γ-globulin, steroid, artificial ventilation, and continuous hemodiafiltration (CHDF) improved his general condition. Destructively infected soft tissue was debrided about one month later following successuful infection control. Persistent agranulocytosis, however, forced us to do bone marrow study three months after admission and was found to result from acute myeloid leukemia. Intensive chemotherapy failed to induce remission and the patient passed away about 10 months after admission. An investigation for underlying malignancy was important in any patient showing marked pancytopenia, splenomegaly, severe infection of group G streptococci whose close correlation with malignancy was well known, and agranulosis after recovery from critical sepsis.
