Toxic Shock Syndrome In A Young Female

A 20 year old female university student presents to the emergency department with a 12 hour history of fever, chills and generalized body aches and pains. On arrival she is noted to be confused, breathless and hypotensive with a sinus tachycardia.

Palmar desquamation seen in the above patient.

What is the differential diagnosis?


Differential Diagnosis:

1. Toxic Shock Syndrome: is a severe illness caused by toxin producing staphylococci. It occurs particularly in women in association with tampon use. Onset is acute with high fever, myalgia and shock. An erythematous sunburn like rash and renal impairment are both common. Palmer desquamation as shown in above picture is common after toxic shock.

2. Meningococcal septicaemia: occurs mainly in children and young adults, and may occur in the absence of meningitis. It is important to look for the characteristic petechial/purpuric rash although it may not always be present.

3. Non- Meningiococcal septic shock: look for other focus of infection like skin, respiratory tract, urinary tract or intra abdominal such as cholangitis.