Toxic shock syndrome: a diagnostic difficulty

Abstract number: 1134_02_153

Thomas S., Waghorn D., Lyons M.


Toxic shock syndrome (TSS), is an acute, non-contagious systemic illness. It is caused by the toxin producing strains of S. aureus and the b-haemolytic streptococci and can occur in any non-immune person exposed to a TSS toxin. TSS is commonly associated with menstruation and tampon use, however can also be related to skin or soft tissue infections, particularly post surgical, skeletal infections or respiratory tract infection. TSS is often non-immunising and recurrent menstrual-associated TSS is well-described. Literature suggests that TSS is extremely rare, but diagnostic difficulties can lead to misdiagnosis and TSS can be fatal if left undiagnosed. We report a series of three cases of TSS, presenting within a short period of time.

Case Reports:

Case 1. 17 year old female, presented with sudden onset collapse, diarrhoea, vomiting and abdominal pains. She gave no history of menstruation and an initial diagnosis of severe gastroenteritis was made. She failed to respond to conservative management and required ITU support. She was discharged with no firm diagnosis and re-presented one month later with similar symptoms, when a diagnosis of staphylococcal TSS was confirmed. Case 2. 15 year old female, presented during menses with sudden onset rash, rigors, severe diarhhoea, vomiting and abdominal pains. She was diagnosed with staphylococcal TSS on admission. Case 3. 28 year old female. Presented with sudden onset severe diarrhoea, vomiting, pyrexia and rash. She gave no history of menstruation. She responded poorly to treatment, required ITU support, high dose steroids and was eventually diagnosed with streptococcal TSS.


Diagnostic criteria for TSS include high fever, hypotension, erythematous rash and a complicated multisystem disfunction. Patients often require aggressive management. The Public Health Laboratory Service reports an average of 18 cases of diagnosed TSS in the UK per year. However, because of the uncommon and difficult nature of the diagnosis, many cases are misdiagnosed and therefore go unreported. It is essential to maintain a high level of suspicion for patients who are epidemiologically at high risk, but importantly, also the less ill patient with suggestive symptoms who fails to meet all diagnostic criteria but are in an at-risk group. High morbidity and mortality has been reported for undiagnosed and untreated cases.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Location: Oxford, UK
Presentation type:
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