{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:52:53Z","timestamp":1792601573843,"version":"4.5.0"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>This article reports a case of an 8-year-old child who developed Streptococcal Toxic Shock Syndrome (STSS) and Acute Respiratory Distress Syndrome (ARDS) following adenotonsillectomy, summarizing the diagnostic and treatment process. Preoperative blood tests, CRP levels, and chest x-rays of the child showed no abnormalities. However, within two hours after surgery, the patient exhibited high-grade fever, dyspnea, and altered mental status, rapidly progressing to shock and ARDS. Although shock was not diagnosed promptly in the early stage, leading to non-standardized fluid resuscitation therapy, blood pressure and heart rate eventually stabilized after adjusting the fluid resuscitation protocol and combining vasoactive medications. The diagnosis of STSS was ultimately confirmed based on sputum bacterial culture from endotracheal intubation and targeted next-generation sequencing(tNGS) results. STSS manifests with sudden onset and rapid progression clinically. It is often misdiagnosed in the early stages, resulting delayed treatment of shock and consequently an extremely high mortality rate.<\/jats:p>","DOI":"10.3389\/fped.2025.1717143","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T06:28:37Z","timestamp":1764311317000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Streptococcal toxic shock syndrome with acute respiratory distress syndrome following adenotonsillectomy in a child: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Wenhai","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijun","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keze","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1128\/CMR.00101-13","article-title":"Disease manifestations and pathogenic mechanisms of group A Streptococcus","volume":"27","author":"Walker","year":"2014","journal-title":"Clin Microbiol Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1097\/01.inf.0000091361.22838.77","article-title":"Invasive group A streptococcal infection after tonsillectomy","volume":"22","author":"Timmers-Raaijmaakers","year":"2003","journal-title":"Pediatr Infect Dis J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"101851","DOI":"10.1016\/j.legalmed.2021.101851","article-title":"Streptococcal toxic shock syndrome with fatal outcome: report on four forensic autopsy cases","volume":"50","author":"Torimitsu","year":"2021","journal-title":"Leg Med (Tokyo)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1605","DOI":"10.3760\/cma.j.cn101070-20220831-01015","article-title":"Chinese expert consensus on diagnosis, treatment and prevention of group A streptococcal infection-related diseases in children","volume":"37","author":"Yu","year":"2022","journal-title":"Chin J Appl Clin Pediatr"},{"key":"B5","article-title":"Toxic Shock Syndrome (Other Than Streptococcal)","year":"2011"},{"key":"B6","volume-title":"Streptococcus pyogenes: Basic Biology to Clinical Manifestations","author":"Ferretti","year":"2022"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e0006335","DOI":"10.1371\/journal.pntd.0006335","article-title":"Group A Streptococcus pharyngitis and pharyngeal carriage: a meta-analysis","volume":"12","author":"Oliver","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Crit Care Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"S147","DOI":"10.1016\/S0163-4453(17)30206-2","article-title":"Toxic shock syndrome\u2014the seven rs of management and treatment","volume":"74","author":"Wilkins","year":"2017","journal-title":"J Infect"},{"key":"B10","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1080\/17843286.2018.1538662","article-title":"Streptococcal toxic shock syndrome in a returning traveller","volume":"74","author":"Note","year":"2019","journal-title":"Acta Clin Belg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.7507\/1002-0179.202405074","article-title":"Application of regional citrate anticoagulation in continuous renal replacement therapy for patients with sepsis and hyperlactatemia","volume":"39","author":"Zheng","year":"2024","journal-title":"West Chin Med J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/S1473-3099(24)00683-7","article-title":"Adjunctive linezolid versus clindamycin for toxin inhibition in \u03b2-lactam-treated patients with invasive group A streptococcal infections in 195 US hospitals from 2016 to 2021: a retrospective cohort study with target trial emulation","volume":"25","author":"Babiker","year":"2025","journal-title":"Lancet Infect Dis"},{"key":"B13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1051\/ject\/201749007","article-title":"Hyperlactatemia and cardiac surgery","volume":"49","author":"Minton","year":"2017","journal-title":"J Extra Corpor Technol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1717143\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T06:28:45Z","timestamp":1764311325000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1717143\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":13,"alternative-id":["10.3389\/fped.2025.1717143"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1717143","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,28]]},"article-number":"1717143"}}