Case ReportWaterhouse-Friderichsen Syndrome After Infection With Group A Streptococcus
Section snippets
REPORT OF A CASE
A 32-year-old previously healthy man presented to the emergency department because of severe neck pain, odynophagia, and fevers of 2 days’ duration. He denied having any recent history of dental procedures or bacterial pharyngitis. His only ill contact was his sister, who had a sore throat. He specifically denied use of nonsteroidal anti-inflammatory drugs or other medications. He denied intravenous drug use and reported an allergy to penicillin.
Physical examination revealed a moderately
DISCUSSION
Our patient had a rapidly progressive course despite prompt administration of appropriate antibiotics. Antemortem blood cultures confirmed GAS bacteremia. In addition, autopsy findings revealed bilateral adrenal hemorrhage consistent with Waterhouse-Friderichsen syndrome. Based on a MEDLINE search of cases in the English language since 1966, this is the third reported case of Waterhouse-Friderichsen syndrome associated with GAS and the first case in an adult.4,5
The earliest reports of this
CONCLUSION
In this patient we documented the presence of GAS in the blood and the presence of GAS antigens in the tissues, as confirmed by immunohistochemistry studies. This case is unique in that our patient had no laboratory evidence of DIC and no dermatologic or pathologic findings consistent with DIC, suggesting that the adrenal hemorrhage was likely mediated by a bacterial toxin.
We thank Patrick M. Schlievert, PhD, University of Minnesota, Minneapolis, for toxigenicity testing of the patient isolate
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2010, International Journal of Infectious DiseasesCitation Excerpt :Together with the above-mentioned clinical symptoms and laboratory results, our patient fulfilled the proposed criteria for STSS.28 We administered high dose steroids, since severe STSS can be associated with lethal bilateral adrenal hemorrhage (Waterhouse–Friderichsen syndrome).29 Evidence for the use of IVIG in the management of STSS is scarce, and since it is a rare disease, it has been difficult to conduct a randomized controlled trial.