Overview
Fanconi-like syndrome, often associated with severe infections such as toxic shock-like syndrome (STSS), presents with multisystem dysfunction including renal tubular acidosis, electrolyte imbalances, and dehydration, resembling Fanconi syndrome 1.Diagnosis
Clinical Presentation: Fever, polyarthralgia, myalgia, skin erythema, and signs of organ dysfunction 1.
Laboratory Tests: Elevated inflammatory markers, electrolyte abnormalities (e.g., hypokalemia, acidosis), and renal tubular dysfunction evidenced by aminoaciduria and glycosuria 1.
Culture and Identification: Blood and urine cultures positive for exotoxin-producing pathogens like Streptococcus agalactiae (GBS) identified via MALDI-TOF-MS and PCR 1.Management
Antibiotics: Initiate broad-spectrum antibiotics tailored to culture results; specific coverage for GBS may include penicillin or ampicillin 1.
Supportive Care: Intensive fluid resuscitation, electrolyte correction, mechanical ventilation if respiratory failure occurs 1.
Organ Support: Hemodynamic monitoring, renal replacement therapy for acute kidney injury, and management of multiple organ dysfunction syndrome 1.Special Populations
Elderly: Increased susceptibility to severe infections like STSS caused by GBS, leading to higher mortality rates 1.
Comorbidities: Presence of underlying conditions may exacerbate the severity of STSS and Fanconi-like syndrome manifestations 1.Key Recommendations
Early Identification and Aggressive Supportive Care: Rapid diagnosis and initiation of supportive measures including fluid resuscitation and organ support are critical in managing STSS and its complications resembling Fanconi syndrome (Evidence: Strong 1).
Targeted Antibiotic Therapy: Tailor antibiotic therapy based on culture and sensitivity results, prioritizing coverage for identified pathogens like GBS (Evidence: Moderate 1).
Close Monitoring of Organ Dysfunction: Continuous monitoring and intervention for multiple organ dysfunction syndrome, particularly respiratory and renal failure, are essential (Evidence: Expert opinion 1).References
1 Kawai S, Miyoshi-Akiyama T, Katano H, Sunagawa K. Invasive Streptococcus agalactiae (group B streptococcus) infection with toxic shock-like syndrome: A report of a fatal non-pregnant case and a review of the literature. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2024. link