Streptococcal toxic shocklike syndrome with necrotizing myositis [Streptococcal toxic shock-like syndrome mit nekrotisierender Myositis]

Streptococcal toxic shock-like syndrome is caused by group A streptococci and characterized by multiorgan failure and soft-tissue necrosis, often in young patients with a bland history and at most a minor trauma. Diagnosis is reached through the clinical presentation, imaging methods and positive bacterial verification. The course is fulminant and in the case of muscle involvement, mortality reaches 80-100 %. Therapy consists of immediate fasciotomy and often of debridement of affected soft tissues with high-dose antibiotics in intensive care. Sometimes an unconfirmed diagnosis must be sufficient to operate. We report the case of a 29-year-old man without an exceptional history who was forced to undergo thigh amputation, multiple soft-tissue debridements, and after a total of 240 erythrocyte concentrates, finally hip joint enucleation.