[Staphylococcal toxic shock syndrome should be considered in the event of diffuse erythema with fever and shock].
Érythème généralisé fébrile et choc : choc toxinique staphylococcique.
Abdominal Pain
/ etiology
Adolescent
Amoxicillin-Potassium Clavulanate Combination
/ therapeutic use
Bacterial Toxins
/ analysis
Clindamycin
/ therapeutic use
Critical Care
Diagnosis, Differential
Drug Therapy, Combination
Enterotoxins
/ analysis
Erythema
/ etiology
Female
Fever of Unknown Origin
/ etiology
Humans
Menstrual Hygiene Products
/ adverse effects
Shock
/ etiology
Shock, Septic
/ diagnosis
Staphylococcus aureus
/ pathogenicity
Superantigens
/ analysis
Exanthema
Exanthème
Staphylococcus aureus
Syndrome de choc toxinique
TSST-1
Tampon
Tampon hygiénique
Toxic shock syndrome
Journal
Annales de dermatologie et de venereologie
ISSN: 0151-9638
Titre abrégé: Ann Dermatol Venereol
Pays: France
ID NLM: 7702013
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
received:
25
04
2018
revised:
24
08
2018
accepted:
03
12
2018
pubmed:
30
1
2019
medline:
18
12
2019
entrez:
30
1
2019
Statut:
ppublish
Résumé
Toxic shock syndrome (TSS) was first described by Todd in 1978. The relevant Lancet publication reported 7 cases of children with fever, exanthema, hypotension and diarrhoea associated with multiple organ failure. An association between TSS and use of hyper-absorbent tampons in menstruating women was discovered in the 1980s. Following the market withdrawal of such tampons, TSS virtually disappeared. Herein we report a new case of TSS in a 15-year-old girl. A 15-year-old patient was admitted to intensive care for severe sepsis and impaired consciousness associated with diffuse abdominal pain. Dermatological examination revealed diffuse macular exanthema. Laboratory tests showed hepatic cytolysis (ASAT 101 U/L, ALAT 167 U/L, total bilirubin 68μmol/L) and an inflammatory syndrome. Lumbar puncture and blood cultures were sterile while thoraco-abdomino-pelvic and brain scans were normal. The patient was menstruating and had been using a tampon over the previous 24hours. Vaginal sampling and tampon culture revealed TSST-1 toxin-producing S. aureus. Management consisted of intensive care measures and treatment with amoxicillin-clavulanic acid and clindamycin for 10 days. In case of septic shock associated with diffuse macular exanthema a diagnosis of TSS must be envisaged, particularly in menstruating women.
Sections du résumé
BACKGROUND
BACKGROUND
Toxic shock syndrome (TSS) was first described by Todd in 1978. The relevant Lancet publication reported 7 cases of children with fever, exanthema, hypotension and diarrhoea associated with multiple organ failure. An association between TSS and use of hyper-absorbent tampons in menstruating women was discovered in the 1980s. Following the market withdrawal of such tampons, TSS virtually disappeared. Herein we report a new case of TSS in a 15-year-old girl.
PATIENTS AND METHODS
METHODS
A 15-year-old patient was admitted to intensive care for severe sepsis and impaired consciousness associated with diffuse abdominal pain. Dermatological examination revealed diffuse macular exanthema. Laboratory tests showed hepatic cytolysis (ASAT 101 U/L, ALAT 167 U/L, total bilirubin 68μmol/L) and an inflammatory syndrome. Lumbar puncture and blood cultures were sterile while thoraco-abdomino-pelvic and brain scans were normal. The patient was menstruating and had been using a tampon over the previous 24hours. Vaginal sampling and tampon culture revealed TSST-1 toxin-producing S. aureus. Management consisted of intensive care measures and treatment with amoxicillin-clavulanic acid and clindamycin for 10 days.
CONCLUSION
CONCLUSIONS
In case of septic shock associated with diffuse macular exanthema a diagnosis of TSS must be envisaged, particularly in menstruating women.
Identifiants
pubmed: 30691878
pii: S0151-9638(18)31281-X
doi: 10.1016/j.annder.2018.12.002
pii:
doi:
Substances chimiques
Bacterial Toxins
0
Enterotoxins
0
Superantigens
0
enterotoxin F, Staphylococcal
0
Clindamycin
3U02EL437C
Amoxicillin-Potassium Clavulanate Combination
74469-00-4
Types de publication
Case Reports
Journal Article
Langues
fre
Sous-ensembles de citation
IM
Pagination
287-291Informations de copyright
Copyright © 2018 Elsevier Masson SAS. All rights reserved.