Toxic shock syndrome: Illustrating the importance of history and examination

Staphylococcus aureus is a gram-positive bacterium that can cause a wide range of infections, with skin involvement such as folliculitis and skin abscesses as well as systemic involvement such as endocarditis and septicaemia. Many strains can produce potent exotoxins leading to distinct clinical syndromes. We present a case of toxic shock syndrome (TSS) caused by Toxic Shock Syndrome Toxin-1 (TSST-1) strain of Staphylococcus aureus.
A 29-year-old woman presented to the emergency department of a tertiary care hospital with fever and an erythematous skin eruption. She was referred to the dermatology department for an opinion. On examination she was febrile (38.4┬░C), and had a wide spread toxic erythema like blanching erythema. She appeared unwell, and the blood pressure was 110/60 mmHg. On direct questioning she mentioned that her skin felt tender to touch, and she felt a burning sensation of the skin, felt faintish at times since the illness and a similar eruption is noted in the vulva as well. On further inquiry she mentioned that she wore one tampon for over 24 hours prior to the eruption. A clinical diagnosis of toxic shock syndrome was made and IV cephazolin, PO clindamycin and normal saline fluids were administered. Endocervical swab revealed Staphylococcus aureus with two sets of blood cultures being negative. She recovered fully without any sequelae. TSS can be fatal if not diagnosed in time and appropriate antibiotics are not given.
This case is presented as an example of how critical the history and examination can be, in making this important diagnosis.

Dr. Andrew Swarbrick

Sir Charles Gairdner Hospital

Currently working at Sir Charles Gairdner Hospital and studying a Masters of Public Health at the University of Western Australia.
Interested in specialising in Dermatology.
Areas of interest include public health and policy, clinical teaching, and information technology.