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Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome: a case report

INTRODUCTION: Streptococcal toxic shock syndrome is a complication of group A streptococcal infection, most often originating from the skin. The syndrome is characterized by fever, hypotension and multiple organ failure. Mortality rate may be as high as 80%. CASE PRESENTATION: A 25-year-old man of I...

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Autores principales: Endeman, Henrik, Ligtenstein, David A, Oudemans-van Straaten, Heleen M
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584008/
https://www.ncbi.nlm.nih.gov/pubmed/18959771
http://dx.doi.org/10.1186/1752-1947-2-338
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author Endeman, Henrik
Ligtenstein, David A
Oudemans-van Straaten, Heleen M
author_facet Endeman, Henrik
Ligtenstein, David A
Oudemans-van Straaten, Heleen M
author_sort Endeman, Henrik
collection PubMed
description INTRODUCTION: Streptococcal toxic shock syndrome is a complication of group A streptococcal infection, most often originating from the skin. The syndrome is characterized by fever, hypotension and multiple organ failure. Mortality rate may be as high as 80%. CASE PRESENTATION: A 25-year-old man of Indian origin presented with abdominal complaints, rash and fever after an episode of pharyngitis. The patient was operated and a biliary peritonitis was found caused by perforation of the cystic duct in the absence of calculi. Cholecystectomy was performed, but after the operation, the patient's condition worsened and multi-organ failure developed. Group A streptococci were cultured in blood taken at admission and streptococcal toxic shock syndrome was diagnosed. Treatment consisted of antibiotics, corticosteroids, immunoglobulin and supportive treatment for haemodynamic, respiratory and renal failure. CONCLUSION: This is a patient with streptococcal toxic shock syndrome complicated by spontaneous perforation of the cystic duct. Spontaneous perforation of the cystic duct is a rare finding, most often reported in children and secondary to anatomic defects. We found only one similar adult case in the literature. Perforation may be due to microthrombosis and ischaemia, and so be a part of the multi-organ failure often found in streptococcal toxic shock syndrome.
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spelling pubmed-25840082008-11-18 Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome: a case report Endeman, Henrik Ligtenstein, David A Oudemans-van Straaten, Heleen M J Med Case Reports Case Report INTRODUCTION: Streptococcal toxic shock syndrome is a complication of group A streptococcal infection, most often originating from the skin. The syndrome is characterized by fever, hypotension and multiple organ failure. Mortality rate may be as high as 80%. CASE PRESENTATION: A 25-year-old man of Indian origin presented with abdominal complaints, rash and fever after an episode of pharyngitis. The patient was operated and a biliary peritonitis was found caused by perforation of the cystic duct in the absence of calculi. Cholecystectomy was performed, but after the operation, the patient's condition worsened and multi-organ failure developed. Group A streptococci were cultured in blood taken at admission and streptococcal toxic shock syndrome was diagnosed. Treatment consisted of antibiotics, corticosteroids, immunoglobulin and supportive treatment for haemodynamic, respiratory and renal failure. CONCLUSION: This is a patient with streptococcal toxic shock syndrome complicated by spontaneous perforation of the cystic duct. Spontaneous perforation of the cystic duct is a rare finding, most often reported in children and secondary to anatomic defects. We found only one similar adult case in the literature. Perforation may be due to microthrombosis and ischaemia, and so be a part of the multi-organ failure often found in streptococcal toxic shock syndrome. BioMed Central 2008-10-29 /pmc/articles/PMC2584008/ /pubmed/18959771 http://dx.doi.org/10.1186/1752-1947-2-338 Text en Copyright © 2008 Endeman et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Endeman, Henrik
Ligtenstein, David A
Oudemans-van Straaten, Heleen M
Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome: a case report
title Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome: a case report
title_full Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome: a case report
title_fullStr Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome: a case report
title_full_unstemmed Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome: a case report
title_short Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome: a case report
title_sort spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584008/
https://www.ncbi.nlm.nih.gov/pubmed/18959771
http://dx.doi.org/10.1186/1752-1947-2-338
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