{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T04:34:35Z","timestamp":1741754075796,"version":"3.38.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"3-4","license":[{"start":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T00:00:00Z","timestamp":1716336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,27]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>An 18-year-old male active duty US Army service member presented to the emergency department with a lower leg abscess in the region of a previously debrided methicillin-resistant Staphylococcus aureus abscess. After initial presentation, the patient became hypotensive, exhibited signs of renal failure, and developed a diffuse erythematous rash. Streptococcus pyogenes was grown from intraoperative cultures, and he was diagnosed with Streptococcal toxic shock syndrome (STSS). The patient subsequently underwent multiple surgical debridements, intravenous immunoglobulin treatment, and intravenous antibiotic administration. Streptococcal toxic shock syndrome may have a rapid onset and cause a sharp decline in hemodynamic status requiring admission to the intensive care unit. Any source of virulent Streptococcal pyogenes infection can cause STSS, including lower extremity abscesses. Therefore, it is imperative for physicians to recognize systemic involvement of seemingly isolated extremity infections. We encourage a high index of suspicion in treating bacterial abscesses for possible complications, and close monitoring of patient status. This suspicion should be even higher during outbreaks of bacteria that can cause STSS, much like the patient presented here.<\/jats:p>","DOI":"10.1093\/milmed\/usae271","type":"journal-article","created":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T16:40:45Z","timestamp":1716396045000},"page":"886-890","source":"Crossref","is-referenced-by-count":0,"title":["Supervening Abscess Resulting in <i>Streptococcus pyogenes<\/i> Toxic Shock Syndrome Complicated by a Recent MRSA Infection in an Active Duty Military Member"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6676-5530","authenticated-orcid":false,"given":"Erik C","family":"Avis","sequence":"first","affiliation":[{"name":"The Edward Via College of Osteopathic Medicine , Blacksburg, VA 24060,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6301-1644","authenticated-orcid":false,"given":"Daniel R","family":"Blankinship","sequence":"additional","affiliation":[{"name":"The Edward Via College of Osteopathic Medicine , Blacksburg, VA 24060,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8028-6410","authenticated-orcid":false,"given":"Timothy P","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Walter Reed National Military Medical Center , Bethesda, MD 20814,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3951-1938","authenticated-orcid":false,"given":"Kathryn","family":"Lago","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Womack Army Medical Center , Fort Liberty, NC 28310,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janelle L","family":"Robertson","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Womack Army Medical Center , Fort Liberty, NC 28310,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth J","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Womack Army Medical Center , Fort Liberty, NC 28310,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,5,22]]},"reference":[{"issue":"1","key":"2025031111141508100_R1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2018-226123","article-title":"Toxic shock syndrome: the great masquerader","volume":"11","author":"Biswas","year":"2018","journal-title":"BMJ Case Rep"},{"issue":"12","key":"2025031111141508100_R2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.32539","article-title":"Streptococcal toxic shock syndrome: a case report","volume":"14","author":"Silva","year":"2022","journal-title":"Cureus"},{"issue":"6 Pt 2","key":"2025031111141508100_R3","doi-asserted-by":"publisher","first-page":"843","DOI":"10.7326\/0003-4819-96-6-843","article-title":"Clinical and laboratory manifestations of toxic shock syndrome","volume":"96","author":"Tofte","year":"1982","journal-title":"Ann Intern Med"},{"issue":"6","key":"2025031111141508100_R4","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1016\/j.jiph.2012.07.006","article-title":"Group A streptococcus toxic shock syndrome: an outbreak report and review of the literature","volume":"5","author":"Al-ajmi","year":"2012","journal-title":"J Infect Public Health"},{"author":"Centers for Disease Control and Prevention","key":"2025031111141508100_R5","article-title":"Streptococcal toxic shock syndrome: for clinicians"},{"issue":"2","key":"2025031111141508100_R6","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1086\/314872","article-title":"Invasive group A streptococcal infections: T1M1 isolates expressing pyrogenic exotoxins A and B in combination with selective lack of toxin-neutralizing antibodies are associated with increased risk of streptococcal toxic shock syndrome","volume":"180","author":"Eriksson","year":"1999","journal-title":"J Infect Dis"},{"issue":"3","key":"2025031111141508100_R7","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1016\/j.ccc.2013.03.012","article-title":"Toxic shock syndrome: major advances in pathogenesis, but not treatment","volume":"29","author":"Low","year":"2013","journal-title":"Crit Care Clin"},{"issue":"4","key":"2025031111141508100_R8","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/s0736-4679(02)00436-5","article-title":"Fulminant infection and toxic shock syndrome caused by Streptococcus pyogenes","volume":"22","author":"Fox","year":"2002","journal-title":"J Emerg Med"},{"issue":"Suppl 1","key":"2025031111141508100_R9","doi-asserted-by":"publisher","first-page":"S147","DOI":"10.1016\/S0163-4453(17)30206-2","article-title":"Toxic shock syndrome - 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