Myocardial depression in streptococcal cellulitis.

A previously healthy woman developed streptococcal cellulitis of the leg after falling and lacerating her knee. On admission her blood pressure was unrecordable and her respiratory rate greater than 60 beats/minute. Mechanical ventilation was necessary, and plasma volume expansion was started, with little effect. Infusion of dopamine restored the blood pressure to 150/90 mm Hg, but interrupting the infusion for as little as 30 seconds resulted in profound hypotension. Insertion of a second central venous catheter allowed the dopamine to be given continuously, and the infusion was stopped successfully four days after her admission. She eventually made a complete recovery. This case highlights the need for intensive supportive treatment in many streptococcal infections and, in particular, the need for inotropic support.