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'Toxic Strep Syndrome' Associated With Group C Streptococcus

Philip Keiser, MD; Wayne Campbell, MD
Arch Intern Med. 1992;152(4):882-884. doi:10.1001/archinte.1992.00400160162042.
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To the Editor. —  In the June 1988 issue of the ARCHIVES, Bartter et al1 described a toxic shock-like syndrome in patients with group A streptococcal infections and coined the term toxic strep syndrome. Since then, there have been numerous articles2-6 describing the clinical manifestations and virulence factors of "toxic strep syndrome." We recently treated a patient with a toxic shock-like illness that was associated with a group C streptococcal infection. As far as we know, group C streptococcus has not been associated with the toxic strep syndrome or with the pyrogenic exotoxins thought to cause the syndrome.8

Report of a Case.——  A 41-year-old woman was admitted with hemodynamic shock and necrotizing fasciitis of her right calf. She was confused and had marked metabolic and hematologic abnormalities including a serum urea nitrogen concentration of 32 mg/dL, creatinine concentration of 2.0 mg/dL, an elevated aspartate aminotransferase level that


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