• Sho Saito, Namiko Taniuchi, Norio Motoda, Kanta Tsunoda, Junpei Sato, Takahiro Suzuki, Junichi Aoyama, Nobuhiko Nishijima, Masahiro Seike, and Yoshinobu Saito.
• Department of Pulmonary Medicine, Nippon Medical School Musashi Kosugi Hospital, Japan.
• Intern. Med. 2025 Feb 1; 64 (3): 469475469-475.

AbstractWe herein report an autopsy case of streptococcal toxic shock syndrome (STSS) with disseminated intravascular coagulation and multiple cerebral infarctions induced by Streptococcus dysgalactiae subsp. equisimilis in an 84-year-old male. Pathological examination revealed sepsis with hemophagocytosis in the reticular system and intravascular bacteria in multiple organs, originating from bacterial necrotizing fasciitis of the lower extremities. The brain MRI findings showed a diffusion weighted imaging-fluid-attenuated inversion-recovery mismatch, whereas the pathology was almost normal, thus supporting a hyperacute phase of cerebral infarction. The findings in this case help to elucidate the pathogenesis of STSS and develop appropriate treatment strategies.

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