Streptococcal Toxic Shock Syndrome Secondary to Salpingitis and Panperitonitis in aPreviously Healthy Nongravid Woman
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초록
사슬알균독성쇼크증후군은 패혈성쇼크증후군과는 다른 임상상을 보이며 중대한 임상 경과를 보인다. 이 질환은 호흡기, 피부, 여성생식기를 통하여 감염이 성립된다. 본 증례는 평소 건강했던 31세 가임기 여성으로 정상적인 생리 주기의 시작과 동시에 급성난관염과 복막염이 발병하였다. Streptococcus pyogenes가 복수로부터 배양되었으며, 혈액 배양은 음성이었다. 임상 경과 중 초기에 쇼크가 발생하여 이 후 지속되었고, 급성신부전, 간손상, 급성호흡곤란증후군, 혈소판 감소를 포함한 범발성 혈관내 응고증, 피부가 벗겨지는 수포성 피부발진을 보여 사슬알균독성쇼크증후군으로 확진된 예이다. Penicillin G, clindamycin, 면역글로불린, 스테로이드 등의 치료에도 반응하지 않고 치명적인 임상 경과를 보였다.
Abstract
Streptococcal Toxic Shock Syndrome (STSS) is one of reemerging infectious diseases, most common sources of which are skin and throat. In this report, we present a case of decompensated STSS originated from unusual clinical situation. A 31-year-old previously healthy nongravid woman presented with acute onset, diffuse abdominal pain:she was diagnosed with acute panperitonitis and acute salpingitis. Culture from the peritoneal cavity was positive for Streptococcus pyogenes. Clinical and laboratory finding not the criteria of STSS:hepatic injury, acute renal failure, acute respiratory distress syndrome, disseminated intravascular coagulopathy, desquamative rash with bullae, and soft tissue necrosis. Hemodynamic shock was managed with fluid and inotropics. Initial broad-spectrum antibiotics were changed to combination therapy of intravenous penicillin G and clindamycin after diagnosing of STSS. Gamma globulin was administered intravenously. Acute hypoxemic respiratory failure was managed with mechanical ventilation. The patient died of multi-organ dysfunction syndrome ten days after the disease onset. Because STSS may be one of the reemerging infectious diseases with grave illness and have different clinical course in contrast to septic shock, earlier confirmative diagnosis and constitution of proper antibiotic therapy are mandatory for better outcome.
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