STREPTOCOCCAL TOXIC SHOCK SYNDROME WITH INITIAL FOCUS IN THE OROPHARYNX REGION: A CASE STUDY

Abstract

Introduction: Toxic shock syndrome can occur after many soft tissue infections by streptococci or staphylococci. Objective: To describe a case study of streptococcal toxic shock syndrome with an initial focus on the oropharynx. Methodology: Descriptive study with collection of secondary information from a patient's electronic medical record. Case study: Female, 17 years old, with asthenia, rash, nausea, vomiting, persistent fever, odynophagia, sandpaper-like skin, Filatov's sign and respiratory failure. She was diagnosed with streptococcal toxic shock with a focus on the oropharynx. She had two episodes of syncope and volume-refractory hypotension. Laboratory tests already showed azotemia. She used norepinephrine 0.4 mcg/kg/min and also supplemental oxygen. She evolved with worsening of shock and was submitted to mechanical ventilation support. The distributive shock that required norepinephrine and adrenaline resolved within 72 hours. Human immunoglobulin was required for 3 days, as well as antibiotic therapy. She was in poor general condition, but she was lucid and oriented, tachydyspneic on room air (SpO2 81%), acyanotic, anicteric, and warm to the touch. After five days, she developed a new worsening of her lungs. After 24 hours of this condition, she had considerable clinical improvement and improvement in her ventilatory parameters, and mechanical ventilation support was withdrawn. She presented delirium with persecutory ideations and critically ill neuropathy. She was scheduled to be transferred to a medical clinic for continued treatment. The psychology records indicate that the patient was in a euthymic mood. She was discharged without sequelae due to clinical improvement of her condition. Conclusion: The speed with which she received medical help and the timely neutralization of the bacteria meant that she was discharged without any sequelae.