Fulminant Shock After Handling Dead Pigs
Clinical Vignette
A 49-year-old woman who works on a small pig farm presents with abrupt onset of fever, myalgias, and headache followed by vomiting and watery diarrhea. Two days earlier, she helped butcher a sick pig and reports several small cuts on her hands from a kitchen knife. She did not wear gloves.
On arrival to the emergency department she is ill-appearing with a temperature of 39.8°C, heart rate 126 beats/min, blood pressure 82/44 mm Hg, and respiratory rate 26 breaths/min. She has a diffuse erythematous blanching rash over the distal extremities with scattered petechiae. She is intermittently confused.
Laboratory testing shows leukocytosis with neutrophil predominance, acute kidney injury, elevated transaminases, and coagulopathy consistent with disseminated intravascular coagulation (DIC). Lactate is elevated. Chest imaging demonstrates bilateral opacities concerning for evolving ARDS.
She is admitted to the ICU, started on vasopressors, and broad-spectrum antimicrobials are initiated. Blood cultures are growing gram-positive cocci in pairs and short chains.
Question
Which of the following is the most likely cause of this patient’s presentation?
Select one option to submit your answer and view live poll results.
References
Tang J, Wang C, Feng Y, Yang W, Song H, Chen Z, et al. Streptococcal Toxic Shock Syndrome Caused by Streptococcus suis Serotype 2. PLOS Medicine. 2006;3(5):e151.