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Volume 348:176-177 January 9, 2003 Number 2
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Case 28-2002: A Traveler with a Rapidly Progressive Soft-Tissue Infection

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by Hoadley, D. J.
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To the Editor: There was no mention of human immune globulin therapy in the discussion of the patient who died from group A streptococcal toxic shock syndrome and necrotizing fasciitis (Case 28-2002) (Sept. 12 issue).1 Yet timely immune globulin therapy might have averted her death. Although no randomized trial of immune globulin therapy for toxic shock syndrome has been performed (or is likely to be performed), observational data and biologic plausibility support its use as a form of passive immunotherapy against the streptococcal superantigens, particularly in critical cases.2,3,4


James R. Johnson, M.D.
Veterans Affairs Medical Center
Minneapolis, MN 55417
johns007@umn.edu

  1. Case Records of the Massachusetts General Hospital (Case 28-2002). N Engl J Med 2002;347:831-837. [Free Full Text]
  2. Schlievert PM. Use of intravenous immunoglobulin in the treatment of staphylococcal and streptococcal toxic shock syndromes and related illnesses. J Allergy Clin Immunol 2001;108:Suppl:S107-S110.
  3. Baracco GJ, Bisno AL. Therapeutic approaches to streptococcal toxic shock syndrome. Curr Infect Dis Rep 1999;1:230-237. [Medline]
  4. Kaul R, McGeer A, Norrby-Teglund A, et al. Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome -- a comparative observational study. Clin Infect Dis 1999;28:800-807. [ISI][Medline]
 
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