{
  "abstract": "An independent, community-dwelling man in his seventies with a medical history of type 2 diabetes mellitus and atrial fibrillation presented to the emergency department with acute-onset confusion. He rapidly developed refractory shock complicated by multi-organ failure, which required multiple vasopressors for haemodynamic support and renal replacement therapy for kidney failure. The early initiation of methylene blue was associated with his rapid stabilisation and improvement. He was found to have an upper extremity wound with group A Streptococcus, leading to the diagnosis of group A Streptococcus toxic shock syndrome. We share this case to encourage consideration of toxic shock syndrome on the differential for refractory septic shock and to highlight the early use of methylene blue in a patient who recovered from shock.",
  "authors": [
    {
      "affiliations": [
        "Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA"
      ],
      "name": "Eric Steinbrook"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA"
      ],
      "name": "Amy S Labar"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Section of Medical Oncology and Hematology, Yale School of Medicine, New Haven, Connecticut, USA"
      ],
      "name": "Hadrian Mendoza"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA"
      ],
      "name": "Alexander Ghincea"
    }
  ],
  "title": "Early use of methylene blue in the management of refractory group A streptococcal toxic shock syndrome with multi-organ failure in the intensive care unit",
  "uid": "1aebd3f9-34bf-5d32-87b4-3e1412c7f0eb"
}