A 16-year-old boy presents to the emergency center with a 2-day history of an abscess with spreading cellulitis. While in the emergency center, he develops a high fever, hypotension, and vomiting with diarrhea. On examination, you note the erythematous rash along with injected conjunctiva and oral mucosa, and a strawberry tongue. He is not as alert as when he first arrived. This rapidly progressive symptom constellation is likely caused by which of the following disease processes?
A. Kawasaki disease
B. TSST-1–secreting S aureus
C. Shiga toxin–secreting Escherichia coli
D. α-Toxin–secreting Clostridium perfringens
E. Neurotoxin-secreting Clostridium tetani
The correct answer is B.
Explanation: Toxic shock syndrome (TSS) is usually caused by S aureus, but a similar syndrome (sometimes called toxic shock-like syndrome [TSLS]) may be caused by Streptococcus sp. The strains of S aureus responsible secrete toxic shock syndrome toxin 1 (TSST-1), and can cause "menstrual" TSS (associated with intravaginal devices like tampons, diaphragms, and contraceptive sponges) or "nonmenstrual" TSS (associated with pneumonia, skin infection [as in this patient], bacteremia, or osteomyelitis). The diagnosis is made clinically, and the case description is typical. Treatment includes blood cultures followed by aggressive fluid resuscitation and antibiotics targeting S aureus. Kawasaki is not typically seen in adolescents, and is not so rapidly progressive. Shiga toxin–producing strains of E coli and Shigella are usually associated with hemolytic-uremic syndrome. Clostridium perfringens can secrete several toxins; one is an α-toxin that causes hemolysis, platelet lysis, increased vascular permeability, and hepatotoxicity. The neurotoxin secreted by C tetani causes tetanus.
Source: Pediatrics: PreTest® Self-Assessment and Review, Fourteenth Edition Copyright © 2016 by McGraw-Hill Education.
Photo Credit: The Color Atlas of Pediatrics