Prodromal symptoms of streptococcal toxic shock syndrome caused by Group A Streptococcus in the head and neck region: a case report
2020
Abstract Group A Streptococci (GAS), also known as “flesh-eating bacteria,” can cause a life-threatening systemic infection called streptococcal toxic shock syndrome (STSS). We report a case of GAS infection that initially manifested as bilateral prominent auricular edema in a patient who had received treatment for maxillary cancer. A 42-year-old man was referred to our department for evaluation of prominent swelling of both ears with fever. Examination revealed bilateral painless auricular swelling with prominent edema and epithelial sacculation. Laboratory dates showed a marked inflammatory reaction. Various virus tests were negative, and computed tomography (CT) also denied phlegmone in systemic inflammation. The authors empirically start administration of intravenous antibiotics. Two days later, GAS was detected from the blood culture, and the patient received a final diagnosis of GAS infection but the disease did not extend to STSS. As CT imaging revealed the possibility of osteomyelitis of the upper jaw, broad-spectrum antibiotics were administered for 4 weeks. All symptoms, including epithelial sacculation of both auriculae, completely disappeared with the resolution of GAS. Moreover, a blast crisis in osteomyelitis was never detected to data. Early positive results from blood culture and early initiation of broad-spectrum antibiotic therapy prevented the development of STSS and necrotizing fasciitis. In the present report, epithelial sacculation of the auricula indirectly contributed to the early diagnosis of STSS.
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