IS Case 573: Toxic shock syndrome

Katherine Kaproth-Joslin, MD

Imaging Sciences URMC


Imaging Sciences URMC 2010
Publication Date: 2011-11-17

History

Patient is a 35-year-old woman sent to the emergency department by her OB/GYN when she presented with myalgias, arthralgias, and a diffuse, red erythematous rash on her skin. Patient had recent fetal demise 3 weeks prior and had recently started having vaginal bleeding. Vulva cultures eventually grew Staphylococcus aureus 2+ and Enterbacter aerogenes 1+.

Findings

Pulmonary edema with interval development of pleural effusion and atelectasis.

Diagnosis

Toxic shock syndrome

Discussion

Toxic shock syndrome (TSS) describes an acute, multi-system, toxin-mediated illness caused by either the toxin-producing strains of Streptococcus pyogenes or Staphylococcus aureus [1]. This patient was found to have Staphylococcus associated TSS. Staphylococcus TSS presents with sudden onset of flu-like symptoms with fever, generalized erythematous macular rash, stomach upset, and severe myalgia, leading to confusion, lethargy, and agitation [2]. Desquamation is a late feature of this process, occurring 10-21 days after disease onset. Blood cultures are only positive in 5% of cases. In individuals who go onto multiorgan dysfunction develop bilateral airspace infiltrates consistent with acute respiratory distress syndrome [2].

References

  1. Lappin E, Ferguson AJ. Gram-positive toxic shock syndromes. Lancet Infect Dis. 2009 May;9(5):281-90. PMID: 19393958
  2. Venkataraman R, Sharma S. Toxic shock syndrome: differential diagnoses & workup. eMedicine, Jul 16, 2010, http://emedicine.medscape.com/article/169177-diagnosis

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