Download Staphylococcal Toxic Shock Syndrome

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Lindsey R. Baden, M.D., Editor
Staphylococcal Toxic Shock Syndrome
Bob C.Y. Chan, M.B., Ch.B.
Paul Maurice, M.D.
Christchurch Hospital
Christchurch, New Zealand
[email protected]
A 33-year-old woman presented with a 4-day history of fever and abdominal pain, 7 days after
undergoing a cesarean section. She had diffuse erythroderma, and the blood pressure was 85/48 mm Hg.
A workup revealed elevated creatinine and liver-enzyme levels, and specimens of urine and specimens from
the vagina were cultured and grew Staphylococcus aureus. Her condition worsened over the next day, with acute respiratory distress; subsequently, desquamation of her hands occurred. A diagnosis of staphylococcal toxic shock syndrome
was made. Desquamation is characteristic of staphylococcal toxic shock syndrome, typically occurring 1 to 2 weeks after
the onset of illness and typically involving the palms and soles. Staphylococcal toxic shock syndrome is associated with
a wide variety of clinical settings, such as menstruation, postpartum and postsurgical states, barrier contraceptive
use, staphylococcal pneumonia, sinusitis, and superinfected skin lesions. With supportive care and the administration
of floxacillin, the patient recovered completely. The skin changes resolved within 4 weeks after the onset of illness.
DOI: 10.1056/NEJMicm1213758
Copyright © 2013 Massachusetts Medical Society.
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n engl j med 369;9 nejm.org august 29, 2013
The New England Journal of Medicine
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