Pseudo-toxic-shock Syndrome Due to a Drug Reaction

Abstract

A case is reported of a 13-year-old girl who had an illness initially thought to be toxic shock syndrome but subsequently noted to be a toxic reaction to the anticonvulsant, carbamazepine. The patient was never hypotensive but she was febrile and had a desquamative rash and involvement of three organ systems. Staphylococcus aureus was recovered from the patient's blood and vagina.

Tendon sheath abscess and severe carbamazepine hypersensitivity

“…Alternatively, the tendon sheath may have been a site of staphylococcal infection without enthesitis first being present. We found one report of a 13‐year‐old girl with carbamazepine hypersensitivity and isolation of S. aureus from blood and vaginal swabs 1 …”

“…We found one report of a 13-year-old girl with carbamazepine hypersensitivity and isolation of S. aureus from blood and vaginal swabs. 1 The mechanisms of drug hypersensitivity syndromes are not fully understood. Deficiency of epoxide hydrolase has been implicated.…”

Toxic shock syndrome

“…1, 1988 The differential diagnosis of TSS includes her febrile illnesses associated with rash or hypotension or both (167,189). These include bacterial sepsis, meningococcemia, streptococcal scarlet fever (9,43), staphylococcal scalded skin syndrome, leptospirosis, measles, enterovirus infection with myocarditis, Rocky Mountain spotted fever, and severe drug eruption (16) (e.g., Stevens-Johnson syndrome or toxic epidermal necrolysis [172]). The strict case definition for TSS usually excludes these other illnesses when applied rigidly (189) This probably is related to the phenotypic characteristics of these S. aureus strains, which differ significantly from characteristics of other S. aureus strains (173).…”

Toxic shock syndrome.

“…REV. The differential diagnosis of TSS includes her febrile illnesses associated with rash or hypotension or both (167,189). These include bacterial sepsis, meningococcemia, streptococcal scarlet fever (9,43), staphylococcal scalded skin syndrome, leptospirosis, measles, enterovirus infection with myocarditis, Rocky Mountain spotted fever, and severe drug eruption (16) (e.g., Stevens-Johnson syndrome or toxic epidermal necrolysis [172]). The strict case definition for TSS usually excludes these other illnesses when applied rigidly (189); however, a thorough history and thorough physical examination should be performed to identify epidemiologic and clinical clues which might point to a different etiology, as well as appropriate laboratory tests (cultures and serology) to add additional exclusionary information.…”