Toxic shock syndrome related to simultaneous Staphylococcus aureus epiglottic abscess and group A streptococcal pharyngitis with bacteremia.

A case of toxic shock syndrome (TSS) is reported in which both a TSST-1-producing Staphylococcus aureus strain and a group A beta-hemolytic streptococcal strain (GABHS) were involved. The S. aureus group I strain was isolated from an epiglottic abscess, and the GABHS strain from tonsils and blood cultures. Acute intubation was needed because of obstruction of the airways by swollen and hyperemic mucous membranes in the oro- and hypopharynx together with external edema around the neck. Intravenous therapy with penicillin G was instituted initially on account of GABHS cellulitis and bacteremia. The patient's condition deteriorated during this treatment, and improvement did not occur until drainage and intravenous dicloxacillin therapy was instituted. It is not possible in this case to draw any conclusions as to which of the two organisms caused the TSS or if they were both involved.