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Article in Japanese

Streptococcal toxic shock syndrome with latent necrotizing fasciitis of lower extremities caused by rapidly progressive group A hemolytic streptococcal infection in a young girl

Daisuke YAMASAKI1,2), Yuko TASAKI1,3), Kengo MIYASHITA1), Mika INOUE1), Shinobu SAKAZUME1), Kazuhide OHTA1)

The mortality rate of fulminant type group A hemolytic streptococcal infection, which causes streptococcal toxic shock syndrome (STSS), is very high. This study describes a four-year-old girl, who was admitted on an emergency basis with a 10-day history of lower limb pain without erythema or lower limb swelling. The pain was due to necrotizing fasciitis. Her symptoms suddenly worsened and she died three days after acute exacerbation. Streptococcus pyogenes were detected from various cultures. The clinical course and necropsy findings indicated a diagnosis of sepsis and disseminated intravascular coagulation (DIC) arising due to the necrotizing fasciitis in the lower extremities, thus causing sudden myocardial ischemia and death. Careful assessment of patients who appear normal is necessary, even if necrotizing fasciitis is recognized. Furthermore, children should be examined more carefully, as the complaint can be ambiguous.

1) Department of Pediatrics, Kanazawa Medical Center, National Hospital Organization
2) Department of Pediatrics, Kanazawa University Hospital
3) Department of Nephrology, Shizuoka Children's Hospital

Key words group A streptococcus, streptococcal toxic shock syndrome (STSS), necrotizing fasciitis, myocardial infarction
Received July 24, 2018
Accepted November 6, 2018

31 (1):41─46,2019