Streptococcal Toxic Shock Syndrome Secondary to Retroperitoneal Necrotizing Fasciitis: A Case Report

Streptococcal toxic shock syndrome (STSS) is a fulminant septic shock condition that develops abruptly and progresses rapidly due to infection with Streptococcus pyogenes. The global incidence of STSS has been increasing, and a wide spectrum of clinical manifestations has been reported. We report a rare case of STSS in a previously healthy 43-year-old woman, secondary to retroperitoneal necrotizing fasciitis. The patient presented with fever and right buttock pain and required intensive care within three days of symptom onset due to rapid disease progression. CT revealed fluid collection and increased fat density in the right retroperitoneal cavity. Emergency lavage and drainage of the right retroperitoneum and paravesical space were performed. Cultures of the hematogenous exudate grew S. pyogenes. Following targeted antibiotic therapy, the patient's condition improved. In STSS, patients often deteriorate suddenly despite having no serious underlying comorbidities, frequently progressing to shock and death. Early consideration of STSS in the differential diagnosis, based on clinical presentation, is critical. If STSS is suspected, prompt surgical intervention, ideally within hours, is essential.