# A Rare Case of Streptococcal Toxic Shock Syndrome Associated With Pneumonia

## TL;DR

A rare case of streptococcal toxic shock syndrome linked to pneumonia in a healthy elderly woman is reported, showing improvement without clindamycin.

## Contribution

This case challenges the routine use of clindamycin in STSS by demonstrating successful treatment with alternative antibiotics.

## Key findings

- A 69-year-old previously healthy woman with STSS and pneumonia improved with tazobactam/piperacillin and azithromycin.
- Clinical improvement occurred without using clindamycin, which is traditionally recommended for its antitoxin effects.
- The case highlights the importance of considering STSS in severe respiratory infections even without skin lesions.

## Abstract

Streptococcal toxic shock syndrome (STSS) is a rapidly progressing and life-threatening illness caused by group A Streptococcus (GAS), typically associated with invasive infections such as necrotizing fasciitis and characterized by high mortality rates. Although GAS is an uncommon cause of community-acquired pneumonia (CAP), it can lead to severe illness in both healthy individuals and those with comorbidities. We report a case of STSS with pneumonia in a previously healthy 69-year-old female who presented with severe respiratory distress and shock without skin lesions. Despite the rapid progression typical of STSS, the patient showed remarkable clinical improvement with tazobactam/piperacillin and azithromycin, without the administration of clindamycin. This study challenges the conventional approach that emphasizes clindamycin due to its antitoxin effects, highlighting the importance of individualized therapeutic decisions. This case underscores the necessity of considering STSS in the differential diagnosis of severe respiratory infections in adults, even in the absence of skin manifestations. Further research is needed to clarify the role of antitoxin therapies and to establish evidence-based guidelines for managing STSS, particularly in cases presenting with pneumonia without skin involvement.