Staphylococcal Toxic Shock Syndrome

This is an answer to the Case – Rash on hand after cesarean section in association with fever and hypotension

A 33-year-old woman presented with a 4-day history of fever and abdominal pain, 7 days after undergoing a cesarean section. She had diffuse erythroderma, and the blood pressure was 85/48 mm Hg.

A workup revealed elevated creatinine and liver-enzyme levels, and specimens of urine and specimens from the vagina were cultured and grew Staphylococcus aureus.

Her condition worsened over the next day, with acute respiratory distress; subsequently, desquamation of her hands occurred. A diagnosis of staphylococcal toxic shock syndrome was made.

Desquamation is characteristic of staphylococcal toxic shock syndrome, typically occurring 1 to 2 weeks after the onset of illness and typically involving the palms and soles.

Staphylococcal toxic shock syndrome is associated with a wide variety of clinical settings, such as:

  • menstruation
  • postpartum and postsurgical states
  • barrier contraceptive use
  • staphylococcal pneumonia, sinusitis, and superinfected skin lesions

With supportive care and the administration of floxacillin, the patient recovered completely. The skin changes resolved within 4 weeks after the onset of illness.