Streptococcal Toxic Shock Syndrome due to Streptococcus dysgalactiae subsp. equisimilis from Retroperitoneal Panniculitis during the treatment with anti-IL-6 receptor antibody: A Case Report

Sho Fujimoto; Yoshihiro Eriguchi; Rinto Nakamura; Sota Kamikawa; Akiko Yonekawa; Noriko Miyake; Nobuyuki Ono; Hiroaki Niiro

doi:10.1093/mrcr/rxae001

Streptococcal Toxic Shock Syndrome due to Streptococcus dysgalactiae subsp. equisimilis from Retroperitoneal Panniculitis during the treatment with anti-IL-6 receptor antibody: A Case Report

Mod Rheumatol Case Rep. 2024 Jan 12:rxae001. doi: 10.1093/mrcr/rxae001. Online ahead of print.

Authors

Sho Fujimoto¹, Yoshihiro Eriguchi¹, Rinto Nakamura¹, Sota Kamikawa¹, Akiko Yonekawa¹, Noriko Miyake¹, Nobuyuki Ono¹, Hiroaki Niiro²

Affiliations

¹ Department of Clinical Immunology and Rheumatology/Infectious Disease, Kyushu University Hospital, Fukuoka, Japan.
² Department of Medical Education, Faculty of Medical Sciences, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.

PMID: 38217091
DOI: 10.1093/mrcr/rxae001

Abstract

A 53-year-old man with adult-onset Still's disease developed severe streptococcal toxic shock syndrome (STSS) due to Streptococcus dysgalactiae subsp. equisimilis (SDSE), following retroperitoneal panniculitis. He was receiving tocilizumab (TCZ), an interleukin-6 receptor inhibitor. The modifying effect of TCZ on the immune response and the pathophysiology of SDSE infection may have led to retroperitoneal panniculitis and atypical STSS with delayed shock and flare of soft tissue inflammation.

Keywords: Streptococcus dysgalactiae subsp. equisimilis; streptococcal toxic shock syndrome; tocilizumab; β-hemolytic streptococcus.