Advertisement

Streptococcal Toxic Shock Syndrome in a Pediatric Patient With Intramuscular Venous Malformation in the Neck

  • Norifumi Matsuda
    Affiliations
    Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
    Search for articles by this author
  • Kosuke Ishikawa
    Affiliations
    Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
    Search for articles by this author
  • Emi Funayama
    Affiliations
    Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
    Search for articles by this author
  • Shintaro Mitamura
    Affiliations
    Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
    Search for articles by this author
  • Satoru Sasaki
    Affiliations
    Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital, Sapporo, Hokkaido, Japan
    Search for articles by this author
  • Yuhei Yamamoto
    Affiliations
    Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
    Search for articles by this author
  • Taku Maeda
    Correspondence
    Reprint Address: Taku Maeda, MD, PhD, Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
    Affiliations
    Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
    Search for articles by this author

      Abstract

      Background

      Streptococcal toxic shock syndrome (STSS) is diagnosed based on signs of shock with multiorgan system involvement, a generalized erythematous macular rash, and rapidly progressive and destructive soft tissue infection.

      Case Report

      The patient was a 2-year-old girl with intramuscular venous malformation in the neck in which an infection occurred, developing into STSS.

      Why Should an Emergency Physician Be Aware of This?

      Group A streptococcal infections are common in children and usually have a mild clinical presentation, but may be life threatening in severe cases. Patients with venous malformations are known to have slow-flow anomalies with venous pooling, which can result in hypoxia and possible immune cell dysfunction. Thus, clinicians should be aware of STSS when a patient with venous malformation has a rapidly progressive infection.

      Keywords

      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 Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Stevens DL
        • Tanner MH
        • Winship J
        • et al.
        Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A.
        N Engl J Med. 1989; 321: 1-7
        • Scorletti F
        • Patel MN
        • Hammill AM
        • Ricci KW
        • CMt Myer
        • Dasgupta R
        Sclerotherapy for intramuscular vascular malformations: a single-center experience.
        J Pediatr Surg. 2018; 53: 1056-1059
        • Russell S
        • Watts RG
        • Royal SA
        • Barnhart DC.
        Group A streptococcal infection of an intramuscular venous malformation: a case report and review of the literature.
        Pediatr Emerg Care. 2008; 24: 839-841
        • Tomita K
        • Watanabe E
        • Sadahiro T
        • et al.
        Septic shock due to infected giant venous malformation complicated by massive bleeding.
        Acute Med Surg. 2016; 3: 279-282
        • The Working Group on Severe Streptococcal Infections, Defining the group A streptococcal toxic shock syndrome
        Rationale and consensus definition.
        JAMA. 1993; 269: 390-391
        • Giesbrecht K
        • Förmer S
        • Sähr A
        • Heeg K
        • Hildebrand D
        Streptococcal Pyrogenic Exotoxin A-Stimulated Monocytes Mediate Regulatory T-Cell Accumulation through PD-L1 and Kynurenine.
        Int J Mol Sci. 2019; 20
        • Barnham MR
        • Weightman NC
        • Anderson AW
        • Tanna A.
        Streptococcal toxic shock syndrome: a description of 14 cases from North Yorkshire, UK.
        Clin Microbiol Infect. 2002; 8: 174-181
        • Taylor CT
        • Colgan SP.
        Regulation of immunity and inflammation by hypoxia in immunological niches.
        Nat Rev Immunol. 2017; 17: 774-785
        • Mazoyer E
        • Enjolras O
        • Laurian C
        • Houdart E
        • Drouet L.
        Coagulation abnormalities associated with extensive venous malformations of the limbs: differentiation from Kasabach-Merritt syndrome.
        Clin Lab Haematol. 2002; 24: 243-251