(P106) Toxic Shock Syndrome Secondary to Group a Strep Pharyngitis Leading to Acute Renal Failure, Cardiomyopathy, and Extremity Amputation in 28 Year Old Female

Chief Complaint : Shortness of breath

History of Present Illness : 28-year-old female with history of endometriosis presenting from urgent care with shortness of breath. Patient has had 2 days of URI symptoms with worsening hoarseness and neck swelling. She was using benzocaine spray for her throat pain. Was initially hypoxic to the high 80s and tachycardia to the 180s with EMS. She was placed on oxygen with improvement of her oxygenation. She has a friend who tested positive for COVID 3 days ago, but has had negative test.

Pertinent Physical Exam: Mouth/Throat: Oropharyngeal exudate present.
No elevation of the floor of mouth. Unable to visualize posterior throat. Diffuse swelling of the neck with tenderness. Hoarse voice. No tongue swelling.
and normal pulses. Tachycardia present.
Pulmonary/Chest: She is in respiratory distress (mild).
Decreased breath sounds
Speech garbled
Skin is warm and intact. Turgor is poor. She is diaphoretic.

Pertinent Laboratory Data: WBC: 12.2; Bands 19%; BUN: 31; Cr: 3.61; GFR: 17; Na: 130; Cl: 4; CO2: 17; AG: 19; Covid negative; Blood Cx: Strep pyogenes; Lac 3.9; pH 7.17, Bicarb 16; CO2: 44; Throat culture: Strep pyogenes; troponin 2,0003

Case Discussion: 28 y.o. female with history of endometriosis with hoarseness and neck swelling, found to be hypoxic requiring intubation, found to have septic/cardiogenic shock 2/2 GAS TSS. She was transferred to TUH for c/f stress cardiomyopathy on 2/3 for VA ECMO evaluation (but was temporized without), she was placed on dobutamine gtt now with recovered EF. Hospital course c/b acute renal failure requiring CRRT (now resolved), critical illness myopathy, peripheral limb ischemia 2/2 shock/pressors, VDRF s/p tracheostomy now on trach collar.

References and Acknowledgements (Optional): To be in final report