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Streptococcal toxic shock syndrome and microcirculation paradox: a case report and literature review
Streptococcal toxic shock syndrome and microcirculation paradox: a case report and literature review
Janet S. Aguirre-Sánchez 1 
, Francisco Moreno-Sánchez 1 , Julio C. Rivera-Soto 1 , Jesús G. Hernández-García 1
1 Unidad de Medicina Crítica, Centro Médico ABC, Ciudad de México, México
*Correspondence: Janet S. Aguirre-Sánchez. Email: jaguirre@abchospital.com
Abstract
We report a case, 57-year-old female infliximab therapy for Crohn’s disease who developed fulminant streptococcal toxic shock syndrome due to Streptococcus pyogenes. The clinical course led to refractory cardiogenic shock and consumption coagulopathy, with protein C and antithrombin III depletion in less than six hours. Despite advanced veno-arterial extracorporeal membrane oxygenation support and normalization of macrocirculatory parameters, irreversible tissue necrosis ensued. This case highlights the futility of extracorporeal support once microthrombosis is established and emphasizes the critical importance of ultra-early clinical suspicion in immunomodulated patients facing septic myocardial injury.
Keywords: Toxic shock syndrome. Extracorporeal membrane oxygenation. Microcirculation. Infliximab. Coagulopathy.
