Streptococcal toxic shock-like syndrome. Report of two cases from Italy

Two cases of streptococcal toxic shock-like syndrome that occurred at our hospital are described. They represent the second and third cases reported from Italy. Both patients were women, had a portal of entry from cutaneous infection of a limb and suddenly developed high degree fever, severe hypotension, necrotizing fasciitis, acute renal failure, hepatic damage, thrombocytopenia and bleeding from a stress-related duodenal ulcer. One patient was leukopenic. The first patient needed resuscitation in the intensive care unit and emergency surgical debridement of the affected limb, whereas the second improved with medical therapy, but needed duodenal surgery for uncontrolled bleeding. Both patients slowly recovered and survived. Finally, a short update on the pathogenesis of the syndrome is also presented.