Dermatologic Emergencies

dermatology-emergencieskapak-1-0-25

Staphylococcal Toxic Shock Syndrome

Fatih Ahmet KAHRAMAN
Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara Bilkent City Hospital, Department of Emergency Medicine, Ankara, Türkiye

Kahraman FA. Staphylococcal toxic shock syndrome. In: Oğuztürk H, Görmeli Kurt N, eds. Dermatologic Emergencies. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.60-8.

ABSTRACT

Staphylococcal Toxic Shock Syndrome (TSS) is a clinical condition characterized by the rapid onset of fever, rash, hypotension, and multi-organ system involvement. Risk Factors – primarily following the emergence of a series of menstruation-associated cases linked to recent tampon use. However, at least half of the reported cases of staphylococcal TSS are not menstruation-related. Other associated risk factors include recent surgical procedures and recent infections (involving the skin, soft tissue, or other regions). Clinical Findings – Staphylococcal TSS is charac- terized by a rapid onset of fever, rash, hypotension, and multi-organ system involvement. Dermatological findings present as a diffuse macular erythroderma, followed by desquamation one to two weeks later. The symptoms and signs of TSS develop rapidly (within 48 hours), often in otherwise healthy individuals. Clinical criteria for TSS have been established by the Centers for Disease Control and Prevention (CDC); however, not all patients with TSS meet these cri- teria. Diagnosis – Staphylococcal TSS should be suspected in patients presenting with a rapid onset of fever, rash, hypotension, and multi-organ system involvement. The diagnosis of staphylococcal TSS is made based on clinical find- ings. Clinical Management – The treatment of staphylococcal TSS includes shock management, source control (in- cluding surgical intervention when necessary), and antibiotic therapy. – Shock Management – Shock associated with TSS requires urgent intervention. – Source Control – Surgical wounds may not appear infected due to a diminished inflam- matory response; nevertheless, wound exploration (with debridement if necessary) should be performed in patients with TSS who have recently undergone surgery, and any tampons should be removed. – Antibiotic Therapy – For patients suspected of having TSS, we recommend combination antibiotic therapy that includes an antistaphylococcal agent and a protein synthesis-inhibiting antibiotic such as clindamycin, considering the importance of toxin production in the pathogenesis of staphylococcal TSS.

Keywords: Dermatology; Staphylococcal skin infections; drug eruptions; exanthema

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