Streptococcal toxic shock syndrome (STSS) is a serious and highly fatal infection. Patients without underlying disorders such as immunodeficiency can rapidly develop soft-tissue necrosis, acute renal failure, adult-type acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and multiple organ failure (MOF). It occurs mostly in the limbs and is rare in the head and neck region. We report a case of STSS originating from the right neck. A 65-year-old man underwent partial resection of the tongue and right neck dissection (1-Ⅳ) for tongue cancer (T3N0M0). With a 3-day history of exudate from the wound and 1-day history of sore throat and fever, he was diagnosed with septic shock. Meropenem, Linezolid, large amounts of fluids, and noradrenaline were administered. The gross appearance of the exudate from the wound was ginger-like, and the gram-positive cocci in chains were identified as group A beta-hemolytic streptococci (GAS),
Streptococcus pyogenes. The patient was finally diagnosed as having streptococcal toxic shock syndrome (STSS). Although the antibiotics were switched to Meropenem/Clindamycin, his condition rapidly deteriorated. Serotypes of GAS were T12, M12, and emm12. Superantigens speB and speF were present. GAS is a common cause of sore throat and sometimes can cause STSS. Although it is a rare disease in the head and neck region, it must be taken into consideration as one of the differentiating treatments.
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