Article in Japanese

Group A streptococcal toxic shock-like syndrome and meningitis -a case report-

Koji TAGAWA¹⁾, Katsuyuki MATSUI¹⁾, Takuma KISHIMOTO¹⁾

The authors encountered an 11-year-old girl with streptococcal toxic shock-like syndrome (TSLS), which is observed rarely in children. Due to loss of consciousness after 17 hours from fever onset, she was admitted immediately to the emergency department of the nearest hospital. She had severe sepsis upon arrival. Her clinical statistics showed a white blood cell (WBC) level of 7,500 per μl and C-reactive protein (CRP) level of 21.0 mg/dl. Besides these symptoms, she displayed hepatic and renal dysfunction, and disseminated intravascular coagulation (DIC). The number of polymorphonucleocytes in her cerebrospinal fluid was extremely elevated. She was administered bolus normal saline and antibiotics, but developed septic shock. She was transferred subsequently to this hospital and received intensive care to withdraw from the septic shock. On day 5 of her fever, group A Streptococcus was detected in her blood and cerebrospinal fluid cultures that were sampled at the time of admission. Based on these findings, a diagnosis of TSLS was made. She responded well to antibiotic treatment, but developed higher cerebral dysfunction. Although group A streptococcal meningitis is rare, it presents with a poor prognosis and has the risk of further development of TSLS. The number of reported TSLS cases correlates positively with the number of reported cases of group A streptococcal pharyngitis. TSLS can be fatal if rapid progression of the disease is not treated and controlled appropriately. Patients with a rapid progression of septic shock require quick and appropriate initial treatment to circumvent the possibility of TSLS onset.

---

1) Department of Pediatrics, Shiga University of Medical Science

Key words
Received	October 7, 2015
Accepted	April 7, 2016

28 (2)：91─97,2016