# Streptococcal Toxic Shock Syndrome Caused by Cellulitis Following a Fall: A Report of Two Critical Cases

## TL;DR

Two elderly patients developed life-threatening streptococcal toxic shock syndrome after minor leg injuries from falls, highlighting the need for early detection in similar cases.

## Contribution

Reports two critical cases of STSS following post-traumatic cellulitis in elderly individuals, emphasizing the risk of minor wounds as entry points for infection.

## Key findings

- Both patients developed STSS after cellulitis from falls, with rapid progression to organ failure.
- GAS was confirmed as the causative agent in both cases through blood and tissue cultures.
- Early recognition and treatment are crucial for improving outcomes in STSS cases.

## Abstract

Streptococcal toxic shock syndrome (STSS) is a life-threatening condition characterized by a sudden onset and rapid progression to multiple organ failure. The pathogen involved is Group A streptococcus (GAS).

We report two cases of STSS that developed following post-traumatic cellulitis in elderly individuals residing in an assisted living facility. The first case involved a 93-year-old male. He developed cellulitis in his right leg after a fall, which rapidly progressed to multiple organ failure. Despite antibiotic therapy, he succumbed to the infection within 30 hours of admission. Blood culture detected GAS. The second case was a 72-year-old man. He developed cellulitis after falling and hitting his leg. He initially received oral antibiotics for cellulitis, but his condition worsened rapidly, requiring emergency amputation and intensive care. Although he temporarily recovered, he later developed severe pneumonia and passed away. A culture of necrotic tissue obtained during surgery confirmed the presence of GAS.

STSS is an invasive infection with a high mortality rate, often triggered by minor skin injuries. Although STSS following minor trauma has not been previously reported, our findings suggest that even minor wounds from falls can serve as an entry point for GAS, leading to severe infection. Given the increasing prevalence of STSS in Japan, healthcare providers, particularly in facilities caring for elderly individuals, should maintain a high index of suspicion for early detection and intervention.

We present two cases of STSS following post-traumatic cellulitis. With the rising incidence of STSS in Japan, early recognition and prompt treatment are crucial in all healthcare settings to improve patient outcomes.