J Korean Soc Ther Radiol Oncol.  2006 Dec;24(4):317-321.

Streptococcal Toxic Shock Syndrome Occurred during Postoperative Radiotherapy in a Cancer Patient with Preexisting Lymphedema and Chronic Illness: Case Report

• Jang JY
• Oh YK
• Kim DM

Abstract

A case is reported of a man with malignant fibrous histiocytoma (MFH) in right thigh who developed streptococcal toxic shock syndrome (STSS) during postoperative radiotherapy. Before radiotherapy, a patient complained wax and wane lymphedema following wide excision of tumor mass which was confirmed as MFH. He took some nonsteroidal antiinflammatory drug (NSAID) for about one month. He suffered preexisting hepatitis C virus (HCV) infection, diabetes and well-controlled hypertension. The patient received conventional radiotherapy to right thigh with a total dose of 32.4 Gy at 1.8 Gy per day. At last radiotherapy fraction, cutaneous erythematous inflammation was suddenly developed at his affected thigh. At that time, he also complained of oliguria, fever and chills. The patient was consulted to internal medicine for adequate evaluation and management. The patient was diagnosed as suggested septic shock and admitted without delay. At admission, he showed hypotension, oliguria, constipation, abnormal renal and liver function. As a result of blood culture, Streptococcus pyogenes was detected. The patient was diagnosed to STSS. He was treated with adequate intravenous antibiotics and fluid support. STSS is one of oncologic emergencies and requires immediate medical intervention to prevent loss of life. In this patient, underlying HCV infection, postoperative lymphedema, prolonged NSAID medication, and radiotherapy may have been multiple precipitating factors of STSS.

Keyword

Malignant fibrous histiocytoma; Streptococcal toxic shock syndrome; Radiotherapy

MeSH Terms

Anti-Bacterial Agents
Chills
Chronic Disease*
Constipation
Emergencies
Fever
Hepacivirus
Histiocytoma, Malignant Fibrous
Humans
Hypertension
Hypotension
Inflammation
Internal Medicine
Liver
Lymphedema*
Oliguria
Precipitating Factors
Radiotherapy*
Shock, Septic*
Streptococcus pyogenes
Thigh
Anti-Bacterial Agents