We report a 68-year old woman with streptococcal toxic shock-like syndrome (TSLS), who survived after disarticulation of left arm and was analyzed for the focal and circulating levels of inflammatory cytokines. She was admitted because of narcotizing f asciitis of left forearm and a profound shock. We carried out disarticulation because erythematous rash of left arm progressively expanded to the trunk despite antimicrobial chemotherapy. After operation, she rapidly recovered from shock.Streptococcus pyogeneswas isolated from the exudates of the left forearm. We found increased levels of IL-8 and MCP-1 in sera, and also detected increased levels of IL-1β and TNF-α as well as these chamomiles in the exudate of the left forearm before disarticulation. After operation ohe circulating levels of IL-8 and MCP-1 rapidly decreased. A rapid growth of S. pyogenesand released streptococcal pyogenic exotoxin B strongly induce IL-8 and IL-1β production in the left forearm, and a massive release of neutrophil proteases might develop a fluminant fasciitis.
