Streptococcal Toxic Shock Syndrome Manifesting

Group A Streptococcus (GAS) is known to cause infections such as pharyngitis, pneumonia, impetigo, erysipelas, necrotizing fasciitis, and septicemia, and can be complicated by rheumatic fever, glomerulonephritis, and erythema nodosum [1]. In 1987, Cone et al described two patients with severe GAS infections who had clinical features similar to staphylococcal toxic shock syndrome (TSS). This syndrome was designated streptococcal TSS [1]. Due to the availability of effective antimicrobial agents, improvements in sanitation, or a probable decrease in the virulence of the microorganism, the frequency and severity of these infections has declined [2]. However, in the past few years, there appears to have been a change in the spectrum of disease caused by GAS, including more frequent reports of streptococcal TSS. The reemergence of serious infection is probably related to the renewed prevalence of more virulent strains and more susceptible host factors [3]. Here, we report a case of streptococcal TSS with the initial presentation of peritonitis and shock. A high degree of suspicion is important to make this diagnosis and to achieve good therapeutic results.