Apreviously healthy 19-year-old woman has a sudden onset of headache, profound myalgias, profuse vomiting, and diarrhea. The woman is near the end of her menstrual period and is using tampons. She appears to be suffering from toxic shock syndrome (TSS). Which of the following is the most likely skin finding?
Which of the following is another common finding in TSS and is part of the case definition?
- hypertension: systolic BP 160 mmHg
- hyperreflexia
- fever with temperature 102°F
- elevated platelet count 400,000
- hypercalcemia
Answer(s): C
Explanation:
Toxin-producing S. aureus organisms have been implicated in the pathogenesis of TSS and are frequently cultured from the vagina and cervix of affected women. There is no diagnostic laboratory test, and diagnosis is based on the typical clinical findings. Diffuse macular erythroderma (sunburn-like rash) occurs in the first few days of illness, followed by desquamation, usually of the palms and soles 12 weeks later.
Fever, hypotension, and multiorgan-system involvement (GI, CNS, muscular, renal, hepatic, hematologic) are also part of the case definition.
Platelet counts are usually reduced below 100,000. Disorientation may occur but without such focal neurologic signs as hyperreflexia. Complications include shock, arrhythmias, renal failure, respiratory failure, and coagulopathy. Hypercalcemia is not a part of the picture