Hypocalcemia and "toxic" syndrome associated with streptococcal fasciitis

A 35-year-old man suffered a small puncture wound of the right hand and within four days had acute fasciitis of the right upper extremity. Cultures of wound and blood grew a group A beta-hemolytic Streptococcus. Persistent hypocalcemia was recognized daily, and he died ten days after the injury in cardiac failure. Preliminary studies have shown that the organism elaborated two streptococcal pyrogenic exotoxins (SPE-C and a new exotoxin, SPE-D). It is suggested but not proven that the cause of the patient's "toxic" illness may have resulted from the action of these exotoxins.