Richard N. Greenberg, MD
To the Editor: We would like to add several comments to those of Hríbalová (1). Since our case report in 1983, several other investigators have suggested a role for Streptococcus pyogenes as a causative agent for the toxic shock syndrome (2, 3). The possibility that streptococcal pyrogenic exotoxins may have a pathophysiologic role is intriguing, as such a role is often described for staphylococcal toxins in the staphylococcal toxic shock syndrome. We recently isolated a fourth (not previously described) streptococcal pyrogenic exotoxin (SPE-D) from the Streptococcus pyogenes isolated from the patient whose case we previously reported. This strain also produced
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Greenberg RN. Streptococcus pyogenes and Bone Resorption. Ann Intern Med. 1988;109:843. doi: 10.7326/0003-4819-109-10-843_1
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Published: Ann Intern Med. 1988;109(10):843.
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