A case of toxic shock-like syndrome due to group A Streptococcal infection of a neck lesion

Group A streptococci may cause a variety of infections, some of which are severe and may be life-threatening. Patients affected by severe invasive group A streptococcal infection may develop a syndrome characterized by circulatory insufficiency with multiple organ failure, namely, streptococcal toxic shock-like syndrome (TSLS). Here, we report a case of streptococcal TSLS originating from the left neck. A 70-year-old man was referred to our hospital with a diagnosis of deep neck and mediastinal infection. Debridement of his left neck and drainage of anterior and posterior parts of the mediastinum were immediately performed. As Group A streptococci were detected from the effusion and blood, he was diagnosed as having streptococcal TSLS. Intensive systemic care involving long-term administration of penicillin G in addition to drainage of the infection helped him recover from TSLS. He underwent further debridement twice to control local infection. Early diagnosis of and surgical intervention for TSLS are mandatory. Subsequently, appropriate supportive treatment of vital organ dysfunction and administration of penicillin as the antibiotic of choice represent the cornerstones of the management of this syndrome.