Toxic shock-like syndrome様の経過を辿った口底蜂窩織炎の1例

• Published in: 日本口腔外科学会雑誌 Vol. 61; no. 4; pp. 232 - 236
• Main Authors: 片倉, 朗, 栗原, 絹枝, 東郷, 拓也, 白井, 朋之, 酒井, 克彦, 野口, 沙希
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.04.2015
• Subjects: 多臓器不全; 急性呼吸促迫症候群; 敗血性ショック; 毒素性ショック様症候群; 非A群溶連菌
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.61.232

Toxic shock-like syndrome induces rapidly progressive necrotizing fasciitis, shock, and multiple organ failure. It can be fatal, with a mortality rate of 30% to 40%. Group A β -hemolytic streptococci are the causative bacteria. However, in recent years, some infections due to non-group A streptococci have been reported. The patient was a 39-year old man. We confirmed abscess formation at the base of the mouth, and an antiinflammatory operation was conducted with the patient under general anesthesia. Shock developed 4 hours after the operation. The chest radiograph revealed bilateral pulmonary infiltrative shadows, and the patient was given a diagnosis of acute respiratory distress syndrome on the basis of findings of hypoxemia. The patient also had abnormal coagulation due to disseminated intravascular coagulation, elevated total bilirubin levels due to liver failure, and soft tissue necrosis in the left submandibular and buccal regions. Non-group A streptococci were identified in the blood culture and closed pus. Through the cooperation of all associated departments, the patient recovered from shock and survived.