Successful treatment of streptococcal toxic shock syndrome complicated by primary peritonitis and bilateral empyema in a healthy young woman: Identification of uncommon clone emm103 and novel sequence type 1363

Yoshihiko M Sakaguchi; Koichiro Murakami; Hiroyuki Akebo; Ryuichi Minoda Sada; Noriyuki Abe; Takahiro Maeda; Mieko Goto; Takashi Takahashi; Yusuke Takahashi; Eriko Kashihara; Jaegi Shim; Hirofumi Miyake; Kazuhiro Hatta

doi:10.1016/j.idcr.2024.e01927

Successful treatment of streptococcal toxic shock syndrome complicated by primary peritonitis and bilateral empyema in a healthy young woman: Identification of uncommon clone emm103 and novel sequence type 1363

IDCases. 2024 Jan 11:35:e01927. doi: 10.1016/j.idcr.2024.e01927. eCollection 2024.

Authors

Yoshihiko M Sakaguchi^{1

2

3}, Koichiro Murakami¹, Hiroyuki Akebo¹, Ryuichi Minoda Sada^{1

4

5}, Noriyuki Abe⁶, Takahiro Maeda⁷, Mieko Goto⁷, Takashi Takahashi⁷, Yusuke Takahashi^{1

5}, Eriko Kashihara¹, Jaegi Shim¹, Hirofumi Miyake¹, Kazuhiro Hatta¹

Affiliations

¹ Department of General Internal Medicine, Tenri Hospital, Nara, Japan.
² International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan.
³ Ph.D. Program in Humanics, School of Integrative and Global Majors, University of Tsukuba, Tsukuba, Ibaraki, Japan.
⁴ Department of Transformative Protection to Infectious Disease, Graduate School of Medicine, Osaka University, Osaka, Japan.
⁵ Department of Infection Control, Graduate School of Medicine, Osaka University, Osaka, Japan.
⁶ Department of Clinical Laboratory Medicine, Tenri Hospital, Nara, Japan.
⁷ Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences and Ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan.

Abstract

Streptococcal toxic shock syndrome (STSS) has a dramatic clinical course and high mortality rate. Here, we report a case of STSS complicated by primary peritonitis and bilateral empyema. A previously healthy young woman was diagnosed with STSS complicated by primary peritonitis and bilateral empyema. Blood culture results on admission were negative. Sever shock, respiratory failure, systemic inflammation, thrombocytopenia, renal failure, ascites, and pleural effusion occurred, mimicking thrombocytopenia, anasarca, fever, reticulin fibrosis/renal failure and organomegaly (TAFRO) syndrome. Retesting blood cultures identified Streptococcus pyogenes. Gram staining of ascites and pleural fluid indicated gram-positive cocci in chains. Antibiotics, immunoglobulins, and surgical intervention led to recovery without complications. Ex-post genotypic analyses showed uncommon emm103.0 (cluster E3) of emm long sequence (784 base) and novel sequence type 1363. STSS diagnosis can be difficult as it mimics other systemic inflammatory diseases. Therefore, it is crucial for clinicians to perform microbiological examinations from infection foci, even if the initial culture is negative.

Keywords: Empyema; Peritonitis; Streptococcal toxic shock syndrome; Streptococcus pyogenes.

Publication types

Case Reports