Streptococcal toxic shock syndrome after hemorrhoidectomy: A case report

Table 1 Clinical criteria for streptococcal toxic-shock syndrome

Hypotension defined by a systolic blood pressure less than or equal to 90 mmHg for adults or less than the fifth percentile by age for children aged less than 16 years
Multiple organ involvement characterized by two or more of the following:
Renal impairment: creatinine ≥ 2 mg/dL (≥ 177 μmol/L) for adults or ≥ wice the upper limit of normal for age. In patients with preexisting renal disease, > twofold elevation baseline creatinine levels
Coagulopathy: platelets ≤ 100000/mm3 (≤ 100 × 106/L) and/or disseminated intravascular coagulation, defined by prolonged clotting times, low fibrinogen level, and the presence of fibrin degradation products
Liver abnormalities: alanine aminotransferase, aspartate aminotransferase, or total bilirubin levels ≥ twice the upper limit of normal for the patient’s age. In patients with preexisting liver disease, a > twofold increase over baseline levels
Acute respiratory distress syndrome: defined by acute onset of diffuse pulmonary infiltrates and hypoxemia in the absence of cardiac failure or by evidence of diffuse capillary leak manifested by cute onset of generalized edema, or pleural or peritoneal effusions with hypoalbuminemia
A generalized erythematous macular rash that may desquamate
Soft tissue necrosis, including necrotizing fasciitis or myositis, or gangrene
Laboratory criteria for diagnosis:
Isolation of group A streptococcus