Abstract
Toxic shock syndrome is a rare but potentially life-threatening illness caused by exotoxin-mediated Staphylococcus aureus infection. It is a severe systemic disease characterized by a fever, hypotension, multiorgan dysfunction, and diffuse rash with desquamation. If not treated properly, the disease course is devastating and rapidly progresses to death. We herein report a 34-year-old man who developed toxic shock syndrome the day after a minor scald burn injury to the right side of the body, chest wall, abdominal area, and leg (3% of the total body surface area). The patient presented to the emergency department with hypotension, hypoxemia, a fever, diarrhea, a diffuse rash, and conjunctival hyperemia. He was admitted to the intensive-care unit and required immediate systemic management, including continuous hemodiafiltration. We performed immediate surgical revision with bedside debridement. The patient’s general condition improved after surgical treatment. He was discharged 21 days after burn injury. An early diagnosis and systemic management are critical to achieve life-saving outcomes. If a patient presents with the characteristics of toxic shock syndrome, treatment should be initiated as soon as possible with the cooperation of other departments.
(a) The changing clinical features (white blood cell count and C-reactive protein [CRP] level). After surgical debridement, the white blood cell (WBC) count (blue line) stopped increasing, and the CRP level (orange line) gradually decreased. Between days 3 and 5, the combined onset of ARDS and DIC was suspected. Solu-cortef (hydrocortisone sodium succinate, solu-cortef injection 100 mg) and thrombomodulin alpha (rTM) were administered. (b) The changing clinical features (patient body temperature and systolic blood pressure). The yellow line indicates the body temperature. The blue line indicates systolic blood pressure. After surgical treatment, the patient’s fever and hypotension improved. NAd: noradrenaline, CHDF: continuous hemodiafiltration, ARDS: acute respiratory distress syndrome, DIC: disseminated intravascular coagulation
