Toxic shock syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differentiating Toxic Shock Syndrome from other Diseases

Toxic shock syndrome requires all 3 manifestations of fever, hypotension and diffuse scarlatiniform rash (innumerable small red papules that are diffusely distributed plus erythema, which blanches and desquamates one or two weeks after onset of illness). It presents with various signs of infection, hemodynamic dysfunction and organ failure.

Clinical presentation of sepsis and rash needs to be differentiated from other diseases like:

• Gram-negative sepsis
• Scarlet fever

• Viral exanthem
• Rickettsial disease
• Kawasaki disease

• Staphylococcal scalded skin syndrome
• Exfoliative erythroderma syndrome
• Erythema multiforme major
• Drug eruption

Features	Toxic shock syndrome	Kawasaki disease	Scarlet fever
Predisposing factors	Occurs in association with vaginitis during menstruation following tampon use (S. aureus); as a complication of soft tissue infections (S. pyogenes or GAS) or in females undergoing medical abortion (C. sordelii).	Interaction of genetic and environmental factors, possibly including an infection in combination with genetic predisposition to an autoimmune mechanism (autoimmune vasculitis)	Occurs after streptococcal pharyngitis/tonsillitis
Hypotension	Commonly present	Not present	Uncommon
Diarrhea	Present	May be present	Not present
Pastia's sign (puncta and skin crease accentuation of the erythema)	Not present	Not present	Present
Renal faliure	Present	Not present	Uncommon
Pyuria	Renal origin	Uretheral origin
Lymphadenopathy	Not present	Present(acute, non-purulent, cervical)	Cervical lymphadenopathy may be present
Metabolic and electrolyte imbalances	Present (hyponatremia and uremia)	Liver function tests may show evidence of hepatic inflammation and low serum albumin levels	Not present
Epidemiology	Occurs in both adults and children (9:1 female predominance)	Occurs in children, usually age 1-4 years	Distributed equally among both genders

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