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Case report: Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome | Journal of Medical Case Reports BioMed Central Open Access Case report Spontaneous perforation of the cystic duct in streptococcal toxic shock syndrome a case report Henrik Endeman 1 David A Ligtenstein2 and Heleen M Oudemans-van Straaten1 Address 1Onze Lieve Vrouwe Gasthuis Department of Intensive Care Medicine Oosterpark 9 PB 95500 1090 HM Amsterdam the Netherlands and 2Ruwaard van Putten Ziekenhuis Department of Surgery PB 777 3200 GA Spijkenisse the Netherlands Email Henrik Endeman - henrik.endeman@planet.nl David A Ligtenstein - ligtenstein@xs4all.nl Heleen M Oudemans-van Straaten - h.m.oudemans-vanstraaten@olvg.nl Corresponding author Published 29 October 2008 Received 3 June 2008 Journal of Medical Case Reports 2008 2 338 doi 10.1186 1752-1947-2-338 Accepted 29 October 2008 This article is available from http www.jmedicalcasereports.com content 2 1 338 2008 Endeman et al licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License http creativecommons.org licenses by 2.0 which permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited. Abstract Introduction Streptococcal toxic shock syndrome is a complication of group A streptococcal infection most often originating from the skin. The syndrome is characterized by fever hypotension and multiple organ failure. Mortality rate may be as high as 80 . Case presentation A 25-year-old man of Indian origin presented with abdominal complaints rash and fever after an episode of pharyngitis. The patient was operated and a biliary peritonitis was found caused by perforation of the cystic duct in the absence of calculi. Cholecystectomy was performed but after the operation the patient s condition worsened and multi-organ failure developed. Group A streptococci were cultured in blood taken at admission and streptococcal toxic shock syndrome was diagnosed. Treatment consisted of antibiotics .
