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[Rapidly fatal streptococcal toxic shock syndrome due to Streptococcus agalactiae in a patient with chronic myeloid leukemia and cirrhosis]

Hiroko Iizuka, Yasutaka Fukuda, Yosuke Mori, Noriaki Iwao, Michiaki Koike, Masaaki Noguchi, Norio Komatsu
[Rinshō Ketsueki] the Japanese Journal of Clinical Hematology 2019, 60 (8): 910-914
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A 72-year-old woman with chronic myeloid leukemia (CML) and cirrhosis complicated with blood blisters on her right upper arm and ascites was admitted. She presented with shock vital on admission. Initial gram staining of blood cultures showed gram-positive cocci in chains, suggesting streptococcal toxic shock syndrome (STSS). Amputation of the right upper arm was performed owing to necrotizing fasciitis. Despite continued antibiotic therapy and systemic management, the blood blisters rapidly spread to the skin of the whole body, and she died 41 h after admission. Blood and fluid cultures from the blisters showed group B streptococci. Reports of patients with leukemia complicated with STSS are rare, and all cases have followed fatal courses. Particularly in this case, various risk factors, such as neutropenia due to tyrosine kinase inhibitor, neutrophil dysfunction due to cirrhosis, and elderly CML, overlapped. In the future, we believe that the lives of patients with leukemia complicated with STSS may be saved by establishing treatment methods and determining the detailed pathogenesis of STSS.

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