A Patient of Using Presepsin to Diagnose Streptococcal Toxic Shock Syndrome during Anticancer Drug Treatment

Abstract EN

Background.

Streptococcal toxic shock syndrome (STSS) is a rapidly progressive infection, with potentially rapid patient deterioration in a very short period.

We experienced a rare case of STSS during anticancer chemotherapy, and we continuously measured presepsin (P-SEP) and evaluated its usefulness.

Case Presentation.

A 60-year-old woman with pulmonary metastasis from cervical cancer began anticancer chemotherapy.

A fever of >40°C and right lower leg swelling developed on day 3.

Symptoms worsened despite cefmetazole treatment (1.0 g/day).

Blood culture was performed without suspecting STSS.

On day 5, symptoms worsened and acute disseminated intravascular coagulation (DIC) and sequential organ failure assessment (SOFA) scores increased.

C-reactive protein (CRP) increased from 28.8 mg/dl to 35.5 mg/dl and P-SEP also increased from 1,635 to 2,350 pg/mL.

STSS was suspected due to the rapid progression of brown discoloration of the entire right lower leg.

Ceftriaxone 2 g/day and clindamycin 1,200 mg/day were begun.

On the evening of day 5, blood culture revealed rapidly progressive group A streptococci.

After that, symptoms improved rapidly with treatment, and SOFA and DIC scores also decreased.

While CRP remained at about 0.5 mg/dl, P-SEP remained slightly elevated at about 400 pg/mL.

A residual infection focus was suspected.

Contrast-enhanced computed tomography (CT) revealed a capsule-enclosed abscess in the right lower leg soleus muscle on day 32.

Debridement was performed and antibiotics were continued until P-SEP was 88 pg/mL.

CT confirmed the disappearance of the abscess.

Conclusion.

Prompt diagnosis by blood culture and a sufficiently early, appropriate change in antibiotic therapy led to successful recovery from STSS during anticancer chemotherapy without lower limb amputation.

P-SEP was useful in assessment of the residual infection focus and suspending treatments.