Advertisement

Toxic shock syndrome due to group A beta-hemolytic streptococcus presenting with purpura fulminans and limb ischemia in a pediatric patient treated with early microsurgical arteriolysis

      Abstract

      We describe a 2.5 year-old child with toxic shock syndrome due to group A beta-hemolytic streptococcus (GABHS) who presented with purpura fulminans and limb ischemia treated with early microsurgical arteriolysis. The clinical picture of toxic shock syndrome (TSS) presenting with purpura fulminans and limb ischemia is an exceptionally uncommon finding in sepsis due to GABHS. This is the first case of purpura fulminans caused by GABHS reported in Europe and the third one described in the literature (Dhodapkar et al., 2000[
      • Dhodapkar K.
      • Corbacioglu S.
      • Chang M.W.
      • et al.
      Purpura fulminans caused by group A beta-hemolytic streptococcus sepsis.
      ]; Renaud et a., 2011[
      • Renaud C.
      • Ovetchkine P.
      • Bortolozzi P.
      • et al.
      Fatal group A streptococcus purpura fulminans in a child receiving TNF-a blocker.
      ]).

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dhodapkar K.
        • Corbacioglu S.
        • Chang M.W.
        • et al.
        Purpura fulminans caused by group A beta-hemolytic streptococcus sepsis.
        J Pediatr. 2000; 137: 562-567
        • Renaud C.
        • Ovetchkine P.
        • Bortolozzi P.
        • et al.
        Fatal group A streptococcus purpura fulminans in a child receiving TNF-a blocker.
        Eur J Pediatr. 2011; 170: 657-660
        • Piepmeier Jr., E.
        • Hamett-Stabler C.
        • Price M.
        • et al.
        Myositis and fasciitis associated with group A beta hemolytic streptococcal infections: development of a rabbit model.
        J Lab Clin Med. 1995; 126: 137-143
        • Pichichero M.E.
        Group A beta-hemolytic streptococcal infections.
        Pediatr Rev. 1998; 19: 291-302
        • Khan Z.Z.
        • Salvaggio M.R.
        • Sharma S.
        • et al.
        Streptococcus group A infections: eMedicine infectious diseases.
        (last accessed: July 25th, 2009)
        • Sharma Sat
        Toxic shock syndrome: eMedicine critical care.
        (last accessed: July 25th, 2009)
        • Schurr M.
        • Engelhardt S.
        • Helgerson R.
        Limb salvage for streptococcal gangrene of the extremity.
        Am J Surg. 1998; 175: 213-217
        • Boeckx W.D.
        • Nanhekhan L.
        • Vos G.D.
        • et al.
        Minimizing limb amputations in meningococcal sepsis by early microsurgical arteriolysis.
        J Pediatr Surg. 2009; 44: 1625-1630