1 - Pediatric Infectious Diseases Unit. Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa.
2 - Pediatric Intensive Care Unit. Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa.
3 - Pediatric Plastic Surgery Unit. Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa.
- Reunião internacional - 38th Annual Meeting of the European Society for Paediatric Infectious Disease 2020, e-poster
Resumo:
Background Childhood invasive Group A Streptococcal (GAS) is a serious lifethreatening disease. Chickenpox infection is the most important risk factor identified for the acquisition of invasive GAS infection in children. The mortality is about 30-50% and it can rise up to 80% in the presence of necrotizing fasciitis.
Case report: A 3-year-old boy, presented with a generalized pruritic rash and high fever. He was diagnosed with varicella and medicated with aciclovir. In 2 days, he was hypotensive, tachycardic, with severe dehydration, abdominal pain, inflammation signs of the right inguinal region, and pain on the left lower limb. Blood tests identified leucopenia (3350/uL leucocytes) and C-reactive protein value of 286,8mg/L. He showed acute respiratory distress syndrome, acute renal failure, liver involvement, coagulopathy, acute myocardial infarction, pancreatitis, so toxic shock syndrome was diagnosed. He started vancomicin, clindamycin and imunoglobulin. Streptococcus pyogenes growth was observed in blood culture. He was ventilated for fifteen days, with inotropic support in the first eight days. It was identified fasciitis of the left lower limb with osteomyelitis of the femur. In the context of vasopressor dependent shock, it happened ischemia of the last three fingers in both feet, that ended up with bilateral amputation of 3º and 5º fingers. After four months of physical rehabilitation, leg strength has improved even though with some walking difficulties.
Conclusion: The treatment of toxic shock syndrome includes surgery, supportive therapy, immunotherapy as well as appropriate antibiotic use. Clindamycin is more effective as it inhibits SPE-A and SPE-B synthesis and it’s suggested as standard treatment. Early diagnosis, and appropriate therapy initiation are the most important prognostic determinants.
Palavras Chave: varicela-zoster, Streptococcus pyogenes, toxic shock syndrome