2017 Volume 30 Issue 2 Pages 197-201
[Introduction] Streptococcal toxic shock syndrome (STSS) is an infection with a very high mortality rate. We report herein on the occurrence of STSS in the head and neck, the 15th case of STSS in Japan. [Case] The patient was a 46-year-old male. One day after performing curettage for a rash in the right submandibular region, a swelling appeared in the neck and he was brought to our department as an emergency patient on the 2nd day. Vital signs were indicative of shock when he was brought in and a marked inflammatory response with acute renal failure were observed. CT showed inflammation of the skin and soft tissue extending from the neck to the anterior thoracic region and gas shadows in the anterior mediastinum, and a diagnosis of septic shock accompanied by cellulitis of the neck and mediastinitis was made. We performed a mediastinotomy via the neck with a tracheotomy, and administered PIPC/TAZ. In a culture specimen obtained from the operative field, Group A β-hemolytic streptococcus was detected and soft tissue necrosis and disseminated intravascular coagulation were present, leading to a diagnosis of STSS. The patient was managed in the ICU and on day 4 after developing STSS, it abated. On day 35 post-surgery, debridement was performed under general anesthesia and on day 100 the patient was discharged. [Conclusion] The patient's life could be saved through prompt administration of antibiotics and surgical actions as well as appropriate intensive care. STSS is a rare condition but we must still keep it in mind.
