Answer 47 Toxic shock syndrome
A 35 year old woman presented shocked with a one week history of sore throat and fever. Her blood pressure was 80 mmHg systolic, temperature 39.5C and pulse 130. She was mildly jaundiced and had a macular erythematous rash that blanched on pressure. She was oliguric and had biochemical evidence of renal failure. Her creatine kinase was twice the upper limit of normal. The differential diagnosis includes:
False a. myocardial infarction
True b. meningococcal septicaemia
True c. leptospirosis
True d. toxic shock syndrome
True e. Rocky Mountain spotted fever
The diagnosis of toxic shock syndrome requires five of the following:
1. High fever
2. Hypotension
3. Diffuse macular erythematous rash
4. Multi-system involvement
5. Desquamation (10-14 days after shock)
6. As far as possible, exclusion of other possible diagnoses. Blood cultures are usually negative but may be positive for Staph. aureus.
