Toxic shock syndrome - Skin in Child
- Erythema of the palms and soles that desquamates 1-3 weeks after the initial onset
- Diffuse scarlatiniform exanthem that begins on the trunk and spreads toward the extremities
- Erythema of the mucous membranes (strawberry tongue and conjunctival hyperemia)
Staphylococcal TSS – Staphylococcal TSS is caused by S. aureus strains that can produce the toxic shock syndrome toxin-1 (TSST-1). TSST-1 is believed to cause disease via direct noxious effects on end organs, impairing clearance of gut flora-derived endotoxins, and acting as a superantigen leading to massive nonspecific activation of T-cells and subsequent inflammation and vascular leakage. In this form of TSS, risk factors include lacking an antibody to TSST-1, surgical packing, abscesses, surgical mesh, and tampon use.
Streptococcal TSS – Streptococcal TSS is also caused by exotoxins that cause massive stimulation of T-cells via a superantigen mechanism. Clinically, the most common presenting symptom is severe pain in an extremity with or without underlying soft tissue infection. However, in children, streptococcal TSS may present without an identifiable source of infection. It may also be associated with bacteremia, endocarditis, pneumonia, pleural effusion, and/or osteomyelitis. A prodrome of fever, diarrhea, and myalgias is often seen. The macular exanthem seen in staphylococcal TSS is much less commonly found in streptococcal TSS. Approximately 48-72 hours after the initial onset, shock and multiorgan failure follow. In this form of TSS, risk factors include varicella infection, bites, and lacerations.
Both forms of TSS can result in confusion and coma, renal impairment, liver impairment, adult respiratory distress syndrome, and disseminated intravascular coagulation. Supportive measures (intravenous fluids, vasopressors, etc) and appropriate antibiotics are the mainstays of treatment.
A48.3 – Toxic shock syndrome
18504008 – Toxic shock syndrome
- Staphylococcal scalded skin syndrome
- Necrotizing fasciitis – rapidly progressing necrosis of fascia and subcutaneous fat.
- Kawasaki disease – fever lasting for more than 5 days with oral mucosal changes, conjunctival injection, and cervical lymphadenopathy.
- Meningococcemia – rapid decompensation, characteristic petechial eruption caused by Neisseria meningitidis.
- Rocky Mountain spotted fever – characteristic retiform purpura; check for serologies.
- Drug hypersensitivity syndrome (DRESS)
- Exanthematous drug eruption
- Drug-induced erythroderma
- Toxic epidermal necrolysis (TEN) – drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
- Stevens-Johnson syndrome – drug induced, high fevers, skin tenderness, mucosal erosions, and skin detachment about 1-3 weeks after the inciting medication is started.
- Scarlet fever – 1-mm erythematous papules, always elevated WBC with left shift, eosinophilia in up to 20% of patients.
- Erythrodermic psoriasis
- Atopic dermatitis with erythroderma
- Contact dermatitis
- Pemphigus erythematosus
- Pityriasis rubra pilaris