Recurrent <i>Streptococcus agalactiae</i> Toxic Shock Syndrome Triggered by a Tumor Necrosis Factor-α Inhibitor

Abstract

Streptococcal toxic shock syndrome caused by group B streptococcus (GBS) is a rare, but lethal disease. We experienced a 45-year-old woman with pustular psoriasis who developed toxic shock-like syndrome during infliximab treatment. Surprisingly, similar episodes recurred three times in one year with restarting of infliximab treatments. In the third episode, GBS were detected in blood, urine, and vaginal secretion cultures. These episodes of shock syndrome were possibly due to GBS. To the best of our knowledge, this is the first case report of recurrent streptococcal toxic shock syndrome possibly caused by GBS which was induced by anti-TNF-α inhibitor therapy. The restarting of biological agents in patients with a history of toxic shock syndrome should therefore be avoided as much as possible.

Kawasaki disease shock syndrome: Unique and severe subtype of Kawasaki disease

“…The mechanism is mainly via improvement of the vascular reactivity, stabilization of the hemodynamics, and increasing of tissue perfusion. Anti‐TNF has beneficial effects in models of ischemia, but its use has been associated with the development of TSS . Anakinra has recently been shown to be effective against myocardial inflammation and sepsis, therefore this therapeutic agent is intriguing for the treatment of KDSS .…”

“…Anti-TNF has beneficial effects in models of ischemia, but its use has been associated with the development of TSS. 74 Anakinra has recently been shown to be effective against myocardial inflammation and sepsis, therefore this therapeutic agent is intriguing for the treatment of KDSS. 75,76 Harada et al reported the use of plasmapheresis in two KDSS patients, and it has been used successfully in refractory KD.…”