DERMATOLOGY
■ Disease is accompanied by diffuse, nonpruritic, scarlitiniform exanthem
that starts on trunk and spreads centrifugally. Subsequent desquamation
may occur.
■ Other manifestations include conjunctival hyperemia, strawberry tongue,
erythema and edema on palms and soles, hair shedding, and nail loss.
Desquamation of hands and feet commonly occurs 1–2 weeks after onset
of illness.
ETIOLOGY
■ Linked with exotoxin-producing S. aureusand severe group A B-hemolytic
streptococcal infections; associated with tampon use, nonsurgical wounds
(lacerations, burns, ulcers), surgical wounds, and nasal packs
DIAGNOSIS
■ Rapid onset of high fever and hypotension
■ Skin rash: Diffuse, blanching, macular erythema, with nonexudative mucous
membrane inflammation; pharyngitis, “Strawberry tongue,” conjunctivitis, or
vaginitis can be seen
■ Involvement of at least three organ systems (GI, muscular, CNS, renal,
hepatic, or hematological)
DIFFERENTIAL
■ Scarlet fever, streptococcal toxic shock syndrome (STSS), staphylococcal
scalded skin syndrome, Kawasaki disease, exfoliative drug eruptions
TREATMENT
■ IV fluids, ventilatory support, pressors, penicillinase-resistant penicillins, or
vancomycin (if CA-MRSA suspected), drainage/debridement of infected sites
STREPTOCOCCAL TOXIC SHOCK SYNDROMESYMPTOMS/EXAM
■ Affects mostly healthy people between 20 and 50 years old
■ This uncommon syndrome involves multiple organ systems with fever,
hypotension, and skin findings of edema, erythema, or bullae. Desquama-
tion occurs less commonly than in Staph TSS.
ETIOLOGY
■ Invasive soft-tissue Streptococcus pyogenes(group A streptococcus) infec-
tions, such as cellulitis or myositis (look for elevated CK as evidence of
myonecrosis)
TREATMENT
■ Inspect skin for source of infection and palpate muscles for tenderness sug-
gestive of myositis or fasciitis.
■ Aggressive management of source of infection with I&D and debridement
if necessary
■ Parenteral naficillin, oxacillin, or vancomycin or a first-generation
cephalosporin
■ Clindamycin is thought to inhibit production of bacterial toxins and is
considered to be first-line treatment by some.
A strawberry tongue is seen
with toxic shock syndrome,
Kawasaki disease, and scarlet
fever.