A fatal case of toxic shock associated with group A streptococcal cellulitis.

The patient in septic shock presents an imposing challenge to the physician's clinical skills; therapy must be initiated often before important data are obtained to assure optimal outcome for these very ill patients. For the past several decades the term septic shock has been virtually synonymous with gram-negative sepsis, as this syndrome is most frequently caused by the endotoxin sometimes expressed by gram-negative organisms. In susceptible individuals this endotoxin can cause hypotension, mental obtundity, decreased left ventricular function, acute renal impairment, vascular instability, severe hematological derangements, and, in 2 S percent of cases, death.! The early 1980s introduced us to a relatively new player in sepsis: Staphylococcus ourem and the toxic shock syndrome. A series of cases was defined in relation to vaginal tampon use, but since then toxic shock has occurred also in the presence of other staphylococcal infections.2 Recently another gram-positive bacterium has reportedly been associated with sepsis and shock. This organism is well known to office-based family physicians as the cause of many soft tissue infections thought until recently to be "routine": acute pharyngitis, otitis media, acute sinusitis, cellulitis, and erysipelas. The organism is group A ~­ hemolytic streptococcus (GABHS), and there is an increasing number of reports of sepsis and death occurring as complications of one of these so-called routine infections.3-6 These findings are of great importance to office-based family physicians, because many affected patients have been young, otherwise healthy individuals without predisposing immune deficiency or debilitating illnesses. The following is a report of septic shock that recently occurred in my patient.