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Recurrent Streptococcus agalactiae Toxic Shock Syndrome Triggered by a Tumor Necrosis Factor-α Inhibitor

Masataka Yoshida1, Takahiro Takazono, Masato Tashiro

  • 1The Second Department of Internal Medicine, Nagasaki University Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|November 3, 2016
PubMed

Insights

This case report details a rare instance of recurrent streptococcal toxic shock syndrome (STSS) in a patient treated with infliximab. The episodes were linked to group B Streptococcus (GBS) and recurred upon re-administration of the anti-TNF-α therapy.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Dermatology

Background:

  • Pustular psoriasis is a chronic inflammatory skin condition.
  • Anti-TNF-α therapies, like infliximab, are used to manage autoimmune diseases.
  • Group B Streptococcus (GBS) can cause severe infections, including toxic shock syndrome.

Observation:

  • A 45-year-old woman with pustular psoriasis developed toxic shock-like syndrome during infliximab treatment.
  • The patient experienced three recurrent episodes of toxic shock-like syndrome over one year.
  • GBS was identified in blood, urine, and vaginal secretions during the third episode.

Findings:

  • This is the first reported case of recurrent streptococcal toxic shock syndrome possibly caused by GBS.
  • The recurrent episodes were potentially induced by anti-TNF-α inhibitor therapy (infliximab).

Implications:

  • Re-initiation of biological agents in patients with a history of toxic shock syndrome should be carefully considered and potentially avoided.
  • This case highlights a rare but serious complication of anti-TNF-α therapy.
  • Further research is needed to understand the link between GBS, anti-TNF-α therapy, and toxic shock syndrome.

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