Friday, September 14, 2007


A 20 year old woman is brought in by a concerned neighbor to the emergency room. The neighbor reports that she was found vomiting and confused. On exam, the patient has a temperature of 40 C (104 F) and a blood pressure of 85/50. She looks like she has a big sunburn, but as this is San Francisco, that's sort of odd. You get some labs and notice an elevated serum creatinine, AST, ALT, and a platelet count of 80,000/mm2.

This would be the causative agent:

Challenge: What's the diagnosis?

Related Questions:
1. What is seen in the Gram stain?

First image shown under fair use.
Second image shown under GNU Free Documentation License.


Alex said...

1. is it staph aureus? which causes scalded skin syndrome.

Craig said...


The criteria for Toxic Shock Syndrome (and Toxic Shock Like Syndrome) include high fever, hypotension, a diffuse erythematous blanching (“boiled lobster”) rash, and involvement of 3 or more organ systems. Infection may occur through the vagina due to tampon use (with an increased risk with Rely tampons). The causative agent is Staphylococcus aureus which produces a superantigen toxin leading to nonspecific MHC II binding and polyclonal T-cell activation. The Gram stain shows Gram positive cocci in clusters. S. aureus is also both catalase positive and coagulase positive.

The exotin Toxic Shock Syndrome Toxin-1 (TSST-1) is a superantigen that can activate large numbers of T cells (up to 20%), resulting in massive cytokine production. They bind the invariant region of the Class II MHC. IL-1 mediates the high fever.

Sources: McKinnon and Howard, “Evaluating a Febrile Patient with a Rash,” American Family Physician, Aug 15, 2000; Wikipedia; UpToDate.

Craig said...

Scalded skin syndrome affects mostly children.