Incomplete limb ischemia as a complication in a pediatric patient with toxic-shock syndrome

Toxic shock syndrome (TSS) is an acute, life-threatening rare pediatric disease associated with high mortality. Pathogens can be both staphylococci (especially S. aureus) and streptococci (group A streptococci). Due to the exotoxin production of the bacteria, there is a systemic attack with shock symptoms. We present the case of a 3-year-old boy who developed a toxic shock syndrome with multiple organ failure after streptococcal A pharyngitis. In addition, the combination of an indwelling arterial catheter in the left femoral artery, high-dose catecholamine administration and desolate condition of the extremities in the course of the shock syndrome led to a pronounced dermal defect on the left distal lower leg with muscular necrosis. Modern intensive care medicine makes the survival of the most serious diseases possible. Invasive methods are indispensable. Unfavorable constellations, such as hypotension, coagulation disorder and local endothelial injury from arterial or venous vascular access, especially when placed in the femoral vessels, require increased vigilance for thrombus formation. The clinical assessment of skin perfusion or the use of a pulse oximeter is unsuitable for detecting limb ischemia with good collateralisation. Therefore, it would be useful to perform a routine sonography check after the removal of an indwelling arterial catheter, especially in pediatric patients.