Intravenous immunoglobulin as adjunctive treatment for streptococcal toxicshock syndrome associated with necrotizing fasciitis: Case report and review

Streptococcal toxic shock syndrome (STSS) is caused by infection with a tox icogenic strain of Streptococcus pyogenes. Clinical manifestations may be t hose of a mild illness, characterized by malaise, fever, and muscle pain, t o severe sepsis and multisystem organ failure. The syndrome may be associat ed with several invasive infections including necrotizing fasciitis. Treatm ent is primarily surgical debridement of infected tissue with supportive ca re, antibiotics, and hemodynamic monitoring. Intravenous immunoglobulin (IV IG) is reported to have beneficial effects in the management of STSS associ ated with necrotizing fasciitis, The agent was successful in conjunction wi th surgical excision and antibiotics in a patient with necrotizing fasciiti s, toxic shock, and multisystem organ failure. On the basis of this experie nce and a thorough literature review, we concur that IVIG may be a useful a djunct in the treatment of STSS associated with necrotizing fasciitis.