Streptococcal toxic shock syndrome (STSS) is a rare and severe condition characterized by shock and multiorgan dysfunction triggered by bacterial toxin release from Streptococcus pyogenes. We report the case of a 61-year-old female patient with a history of odontogenic infection 10 days prior and acute otitis media under oral antibiotic therapy, who developed bilateral periorbital edema. On admission, she presented rapidly progressive cervicofacial edema, leading to upper airway obstruction and the need for emergency intubation. CT scans of the face, neck, and chest revealed right-sided mastoiditis, bilateral ethmoid sinusitis and left maxillary sinusitis, mucosal edema of the nasopharyngeal and oropharyngeal walls, diffuse facial edema with subcutaneous infiltration extending into the chest, and signs of aspiration pneumonitis. In addition, the patient had bilateral preseptal cellulitis.Vancomycin, piperacillin-tazobactam, and linezolid were initiated. Given the suspicion of necrotizing infection and toxic shock, the regimen was switched to cefepime, daptomycin, and clindamycin, targeting gram-negatives for sinus involvement, gram-positives, and protein synthesis inhibition, respectively. The patient underwent surgical drainage of abscesses, sinus surgery, and tooth extraction. In the immediate postoperative period, she developed a cardiorespiratory arrest that was reversed. The clinical course was marked by acute kidney injury requiring hemodialysis, as well as necrotic lesions on the lips and eyelids, which were debrided surgically. Wound secretion cultures identified Streptococcus pyogenes, confirming the etiology of STSS and allowing antibiotic therapy to be switched to crystalline penicillin (with renal dosing adjustment) plus clindamycin. Despite treatment, the patient remains on mechanical ventilation (tracheostomized), with persistent renal dysfunction and ongoing antibiotic therapy. Multidisciplinary management (otorhinolaryngology, plastic surgery, nephrology, and infectious diseases) has been crucial in addressing the multiple complications. This case highlights the severity and complexity of STSS management, emphasizing the need for integrated care to achieve better outcomes.
Grubert et al. (2026) studied this question.