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Plantar Purpura as the Initial Presentation of Viridians Streptococcal Shock Syndrome Secondary to Streptococcus gordonii Bacteremia


Affiliations
1 Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China
2 Department of Cardiovascular Surgery, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China
 

Viridians streptococcal shock syndrome is a subtype of toxic shock syndrome. Frequently, the diagnosis is missed initially because the clinical features are nonspecific. However, it is a rapidly progressive disease, manifested by hypotension, rash, palmar desquamation, and acute respiratory distress syndrome within a short period.The disease course is generally fulminant and rarely presents initially as a purpura over the plantar region. We present a case of a 54-year-old female hospital worker diagnosed with viridians streptococcal shock syndrome caused by Streptococcus gordonii. Despite aggressive antibiotic treatment, fluid hydration, and use of inotropes and extracorporeal membrane oxygenation, the patient succumbed to the disease. Early diagnosis of the potentially fatal disease followed by a prompt antibiotic regimen and appropriate use of steroids are cornerstones in the management of this disease to reduce the risk of high morbidity and mortality.
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  • Plantar Purpura as the Initial Presentation of Viridians Streptococcal Shock Syndrome Secondary to Streptococcus gordonii Bacteremia

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Authors

Chen-Yi Liao
Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China
Kuan-Jen Su
Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China
Cheng-Hui Lin
Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China
Shu-Fang Huang
Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China
Hsien-Kuo Chin
Department of Cardiovascular Surgery, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China
Chin-Wen Chang
Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China
Wu-Hsien Kuo
Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China
Ren-Jy Ben
Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China
Yen-Cheng Yeh
Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No. 2 Zhongzheng 1st Road, Lingya District, Kaohsiung 802, Taiwan, Province of China

Abstract


Viridians streptococcal shock syndrome is a subtype of toxic shock syndrome. Frequently, the diagnosis is missed initially because the clinical features are nonspecific. However, it is a rapidly progressive disease, manifested by hypotension, rash, palmar desquamation, and acute respiratory distress syndrome within a short period.The disease course is generally fulminant and rarely presents initially as a purpura over the plantar region. We present a case of a 54-year-old female hospital worker diagnosed with viridians streptococcal shock syndrome caused by Streptococcus gordonii. Despite aggressive antibiotic treatment, fluid hydration, and use of inotropes and extracorporeal membrane oxygenation, the patient succumbed to the disease. Early diagnosis of the potentially fatal disease followed by a prompt antibiotic regimen and appropriate use of steroids are cornerstones in the management of this disease to reduce the risk of high morbidity and mortality.