1993 Volume 16 Issue 5 Pages 376-382
Toxic shock syndrome (TSS) is an acute, multisystem illness characterized by high fever, circulatory failure, desquamative skin lesion and multiple organ damage. It is usually associated with a focus of infection with staphylococcus aureus and its exotoxins have been considered to be the major contributing agents in the pathogenesis of TSS. Recently, it has become clear that most of the staphylococcal exotoxins acts as superantigens, activating a large fraction of T cells at the same time. The production of various cytokines induced by these toxins have been implicated in the development of TSS.
We recently experienced a case of TSS in a 15-year-old boy. The characteristic features of the illness developed shortly after the introduction of anti-leukemic chemotherapy for acute myelocytic leukemia. Rapid deterioration of the clinical conditions was associated with high fever, circulatory failure, and evidence of liver damage. Oliguria and increase of BUN were also evident. Generalized erythematous skin lesion appeared at the peak of the illness. The patient's clinical condition recovered after short period of supportive therapy and the characteristic desquamation appeared during the convalescence. Staphylococcus aureus was recovered from the swollen lymph node in the neck.
Antibody titers against TSST-1 and SEB remained high during the illness and did not show any appreciable change. There was no expansion or deletion of T cells with a particular Vβ repertoire during the course of illness. Although no specific toxin was found to be responsible, the characteristic clinical pictures were diagnostic of TSS. Patient's altered defense and the chemotherapy might have changed the growth and toxin producing profiles of the preexisting bacteria.
Serum cytokine levels were measured during the acute stage of the illness. Not only monokine like IL-1β, TNFα and IL-6, but also IFNγ levels were markedly elevated during the acute stage of the illness. These cytokine levels returned quickly to normal values within a few days. The data indicated that the excessive production of the T cell derived cytokines, such as IL-2 and IFN-γ, play major roles in the development of the characteristic clinical picture of TSS.
