Abstract

Background: Streptococcal toxic shock syndrome (STSS) is an uncommon, rapidly progressive condition triggered by toxin-producing group A Streptococcus that carries high morbidity and mortality. Early diagnosis is challenging because initial soft-tissue findings can appear deceptively mild. Prompt identification and aggressive multidisciplinary treatment are therefore critical.
Case Presentation: We describe two men who developed STSS from lower-limb soft-tissue infections. The first, a previously healthy middle-aged patient, deteriorated into septic shock, required surgical debridement and broad antimicrobial therapy, and was later complicated by multidrug-resistant secondary infections before recovering. The second, an older patient with multiple comorbidities, experienced fulminant multiorgan failure that responded only after extensive debridement together with a multimodal regimen of pathogen-directed antibiotics, intravenous immunoglobulin, corticosteroids, hemoperfusion, and continuous renal-replacement therapy. Both patients ultimately survived.
Conclusion: These cases illustrate the clinical heterogeneity of STSS and emphasize that favorable outcomes depend on rapid recognition, early surgical source control, and timely escalation to tailored antimicrobial and immune-modulating therapies when shock is refractory. They further highlight the importance of reassessing cultures throughout treatment to detect secondary pathogens that can undermine recovery. Clinicians should maintain a high index of suspicion for STSS in patients with seemingly limited soft-tissue infection who deteriorate quickly, because prompt deployment of a flexible, multimodal strategy can be lifesaving.

Key words: Keywords: Streptococcal toxic shock syndrome, necrotizing soft-tissue infection, intravenous immunoglobulin, hemoperfusion, case report.