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In the following hours he developed persistent hypotension, acute respiratory distress syndrome, liver failure, kidney failure and disseminated intravascular coagulation. A diagnosis of toxic shock syndrome was made, but despite antibiotic therapy, immunoglobulin administration, and supportive measures, the patient died 50 h after presentation. Streptococcus pyogenes was isolated from blood cultures.<\/jats:p>","DOI":"10.4997\/jrcpe.2018.107","type":"journal-article","created":{"date-parts":[[2018,5,14]],"date-time":"2018-05-14T05:43:16Z","timestamp":1526276596000},"page":"33-35","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Fulminant Streptococcal Toxic Shock Syndrome"],"prefix":"10.1177","volume":"48","author":[{"given":"S","family":"Zavala","sequence":"first","affiliation":[{"name":"Infectious Diseases specialist, Instituto de Medicina Tropical \u2018Alexander von Humboldt\u2019 - Universidad Peruana Cayetano Heredia, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Arias","sequence":"additional","affiliation":[{"name":"Internal Medicine and Intensive Medicine specialist, Intensive Care Unit, Clinica Sanna San Borja, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Legua","sequence":"additional","affiliation":[{"name":"Infectious Diseases specialist, Instituto de Medicina Tropical \u2018Alexander von Humboldt\u2019 - Universidad Peruana Cayetano Heredia, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,3,1]]},"reference":[{"key":"bibr1-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198907063210101"},{"key":"bibr2-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.3201\/eid0103.950301"},{"key":"bibr3-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198707163170305"},{"key":"bibr4-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03500030088038"},{"key":"bibr5-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.14-3-316"},{"key":"bibr6-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1128\/iai.61.8.3369-3374.1993"},{"key":"bibr7-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1128\/iai.57.12.3715-3719.1989"},{"key":"bibr8-jrcpe.2018.107","volume-title":"Streptococcus pyogenes: Basic Biology to Clinical Manifestations","author":"Ferretti JJ","year":"2016"},{"key":"bibr9-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/168.1.232"},{"key":"bibr10-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/165.5.879"},{"key":"bibr11-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/173.3.619"},{"key":"bibr12-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1099\/0022-1317-49-10-849"},{"key":"bibr13-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1988.00380060185032"},{"key":"bibr14-jrcpe.2018.107","first-page":"222","volume":"3","author":"Conly J","journal-title":"Can J Infect Dis"},{"key":"bibr15-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(09)70066-0"},{"key":"bibr16-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-4399(97)82735-3"},{"key":"bibr17-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2004.06.002"},{"key":"bibr18-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-8579(01)00413-7"},{"key":"bibr19-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2014-306601"},{"key":"bibr20-jrcpe.2018.107","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp140359"}],"container-title":["Journal of the Royal College of Physicians of Edinburgh"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4997\/jrcpe.2018.107","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4997\/jrcpe.2018.107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:29:59Z","timestamp":1777616999000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4997\/jrcpe.2018.107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.4997\/jrcpe.2018.107"],"URL":"https:\/\/doi.org\/10.4997\/jrcpe.2018.107","relation":{},"ISSN":["1478-2715","2042-8189"],"issn-type":[{"value":"1478-2715","type":"print"},{"value":"2042-8189","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3]]}}}