Published in:
Open Access 01-12-2017 | Case report
Streptococcal toxic-shock syndrome due to Streptococcus dysgalactiae subspecies equisimilis in breast cancer-related lymphedema: a case report
Published in: Journal of Medical Case Reports | Issue 1/2017
Login to get accessAbstract
Background
Breast cancer-related lymphedema often causes cellulitis and is one of the most common complications after breast cancer surgery. Streptococci are the major pathogens underlying such cellulitis. Among the streptococci, the importance of the Lancefield groups C and G is underappreciated; most cases involve Streptococcus dysgalactiae
subspecies
equisimilis. Despite having a relatively weak toxicity compared with group A streptococci, Streptococcus dysgalactiae
subspecies
equisimilis is associated with a mortality rate that is as high as that of group A streptococci in cases of invasive infection because Streptococcus dysgalactiae
subspecies
equisimilis mainly affects elderly individuals who already have various comorbidities.
Case presentation
An 83-year-old Japanese woman with breast cancer-related lymphedema in her left upper limb was referred to our hospital with high fever and acute pain with erythema in her left arm. She showed septic shock with disseminated intravascular coagulation. Blood culture showed positive results for Streptococcus dysgalactiae
subspecies
equisimilis, confirming a diagnosis of streptococcal toxic-shock syndrome. She survived after successful intensive care.
Conclusions
To the best of our knowledge, this case represents the first report of Streptococcus dysgalactiae
subspecies
equisimilis-induced streptococcal toxic-shock syndrome in a patient with breast cancer-related lymphedema. Breast cancer-related lymphedema is a common problem, and we must pay attention to invasive streptococcal soft tissue infections, particularly in elderly patients with chronic disease.