We reported a case of streptococcal toxic shock syndrome (STSS) due to
Streptococcus mitis (
S. mitis). A 55-year-old woman with SLE admitted to our hospital on April 20, 2004, complaining an acute pain in the right hip. On physical examination, her right hip and leg was enlarged and diffuse purpura was identified. Results of laboratory studies showed CRP of 21.17 mg/dl and CK of 1,006 IU/
l. Though medication of antibiotics and γglobulin were started immediately, purpura spread rapidly and was accompanied by ulceration and necrosis of the skin. Next day the patient became confused and hypotensive. A diagnosis of necrotizing fasciitis was made, and emergency surgical debridement was undertaken. But 5 days later, erythema was prominent around the operative wound and spread again. Second operation was performed on April 28, but in vain. The patient died on May 2 because of multiple organ failure (MOF).
Streptococcus mitis was detected from blood culture and necrosis tissue, so we finally diagnosed the patient as STSS due to
S. mitis.
Streptococcus mitis is one of the most common species of viridans streptococci and generally avirulent. In this country, there was no report of STSS due to
S. mitis, so we thought this case is very rare.
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