Lee CY, Lee YJ, Chen CC, Kuo LJ. Streptococcal toxic shock syndrome after hemorrhoidectomy: A case report. World J Clin Cases 2021; 9(33): 10238-10243 [PMID: 34904094 DOI: 10.12998/wjcc.v9.i33.10238]
Corresponding Author of This Article
Li-Jen Kuo, MD, Chief Doctor, Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, No. 252 Wuxing Street, Sinyi District, Taipei 11031, Taiwan. kuolijen@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 26, 2021; 9(33): 10238-10243 Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10238
Streptococcal toxic shock syndrome after hemorrhoidectomy: A case report
Chien-Yu Lee, Yuarn-Jang Lee, Chia-Che Chen, Li-Jen Kuo
Chien-Yu Lee, Department of Pediatrics, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 32748, Taiwan
Yuarn-Jang Lee, Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
Yuarn-Jang Lee, Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
Chia-Che Chen, Li-Jen Kuo, Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei 11031, Taiwan
Li-Jen Kuo, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
Author contributions: Lee CY wrote the manuscript; Lee YJ and Chen CC participated in patient care; Chen CC collected the data; Kuo LJ reviewed and edited the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Jen Kuo, MD, Chief Doctor, Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, No. 252 Wuxing Street, Sinyi District, Taipei 11031, Taiwan. kuolijen@gmail.com
Received: March 12, 2021 Peer-review started: March 12, 2021 First decision: April 13, 2021 Revised: April 22, 2021 Accepted: October 14, 2021 Article in press: October 14, 2021 Published online: November 26, 2021 Processing time: 255 Days and 4.9 Hours
Abstract
BACKGROUND
Streptococcal toxic-shock syndrome after hemorrhoidectomy is rare but may be catastrophic. Group A streptococci have produced various surface proteins and exotoxins due to genetic changes to fight the human body’s immune response. Though life threatening infection after hemorrhoidectomy rarely occurs, all surgeons should be aware of the potential complications of severe sepsis after hemorrhoidectomy and keep in mind their clinical presenting features in order to diagnose early and administer appropriate and effective therapeutic drugs early.
CASE SUMMARY
Here, we present a case of a 56-year-old man with a painful thrombotic external hemorrhoid who presented to our outpatient department for management. There was no history of systemic diseases or recent disease infection. Hemorrhoidectomy was suggested and performed. After surgery, the patient developed hypotension, tachycardia, fever with chills and renal function impairment on day 2 post-operation. The clinical condition progressed to severe septic shock and metabolic acidosis. The patient responded poorly to treatment and expired after 1 d even with use of extracorporeal membrane oxygenation. The results of the blood and wound cultures showed group A streptococcus pyogenes.
CONCLUSION
Although extremely uncommon, all surgeons should be aware of these potential life-threatening septic complications and alert to the presenting features for patients receiving hemorrhoidectomy.
Core Tip: Group A Streptococcus (GAS; Streptococcus pyogenes) causes a broad spectrum of infections, including skin and soft tissue infections, tonsillitis, postpartum endometritis, puerperal sepsis, necrotizing soft tissue infection, and toxic shock syndrome (TSS). Though GAS infection and streptococcal TSS rarely happen after hemorrhoid treatment, all surgeons should be aware of the potential complications of severe sepsis after hemorrhoidectomy and keep in mind their clinical presenting features in order to diagnose early and administer appropriate and effective therapeutic drugs early.
