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- Ayaho Tsujino, Aki Nakajima, Haruka Yabuta, Joi Sekioka, Masayuki Amano, Shuhei Fujimura, Yosuke Akashi, Shinya Akioka, Kentaro Iwasa, Aiko Okazaki, Masahito Takano, Akihiro Kajita, and Kenji Uno.
- Center of Medical Education and Training, Minami-Nara General Medical Center, Japan.
- Intern. Med. 2024 Jan 1; 63 (15): 220922142209-2214.
AbstractA 66-year-old woman with liver cirrhosis and hemodialysis was referred with a 1-week history of pain and rash on the left lower leg. On an examination, the patient was in shock. She was administered catecholamine support for septic shock and ampicillin/sulbactam for severe cellulitis. Streptococcus dysgalactiae subsp. equisimilis (SDSE) was isolated from the blood culture, and she was diagnosed with streptococcal toxic shock syndrome. Despite therapy, the patient died on day 7 of admission. Infective endocarditis (IE) was diagnosed during an autopsy. Clinicians should be aware that overwhelming SDSE-IE can occur even in the absence of necrotizing fasciitis, especially in immunocompromised patients.
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