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Article in Japanese

A case of streptococcal toxic shock syndrome with osteomyelitis

Emiko HOSHINO, Masahiro SIRAISHI, Atsushi DOYAMA, Yuki KUROIWA, Toshihiko MORI

Streptococcal toxic shock syndrome, caused by Streptococcus pyogenes (STSS), is a life-threatening condition usually associated with some soft tissue infections, such as necrotizing fasciitis. We report a case of STSS associated with osteomyelitis. A previously healthy 5-year-old boy was admitted to hospital with high fever, severe pain in the left lower extremity and disturbed consciousness. Blood and throat swab cultures enabled the isolation of Streptococcus pyogenes, Group A, and the child was diagnosed as having STSS. He was given intravenous antibiotic treatment initially high-dose clindamycin and ampicillin. While this treatment resulted in some relief from the leg pain, the fever persisted. Therefore, the antibiotic treatment was changed to meropenem on the 8th day of hospitalization, after which the fever was resolved and the pain diminished. T2-weighted MRI examination performed on day 15 post admission, revealed high signal intensities in the bone marrow of the left tibia, which were indicative of osteomyelitis. The antibiotic treatment was continued for 8 weeks. The child made an uneventful recovery and was discharged on day 60 post admission. Early recognition of the disease and prompt initiation of appropriate treatment is expected to lead to a successful outcome.

Department of Pediatrics, NTT East Sapporo Hospital

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Received April 5, 2013
Accepted March 3, 2014

26 (2):225─230,2014