Sunday, March 29, 2015

22-year-old female presents with the sudden onset of a high fever

A 22-year-old female presents with the sudden onset of a high fever, a diffuse erythematous skin rash, and shock. She started menstruating at age 13 and for several years has used tampons. Which one of the following is the most likely diagnosis for this individual’s illness? 



a. Erysipelas caused by Streptococcus pyogenes
b. Fifth disease caused by human parvovirus B19
c. Scarlet fever caused by S. pyogenes
d. Secondary syphilis caused by Treponema pallidum
e. Toxic shock syndrome caused by Staphylococcus aureus


The answer is e. Toxic shock syndrome is caused by infection with certain types of S. aureus that secrete the toxin toxic shock syndrome toxin 1 (TSST-1). This toxin is a type ofsuperantigen that binds both class II MHC and TCR outside of the normal antigen-binding groove. As such, this toxin can react with up to 10% of peripheral T cells, which leads to massive T cell activation and shock. 


Clinically, toxic shock syndrome is most often seen in women who use certain tampons that have been colonized with Staphylococcus.

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