Jaime Pareja, MD; Kal Gupta, MD; Henry Koziel, MD
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Pareja J., Gupta K., Koziel H.; The Toxic Shock Syndrome and Staphylococcus lugdunensis Bacteremia. Ann Intern Med. 1998;128:603-604. doi: 10.7326/0003-4819-128-7-199804010-00029
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Published: Ann Intern Med. 1998;128(7):603-604.
TO THE EDITOR:
The toxic shock syndrome is often associated with Staphylococcus aureus and is mediated by toxic shock syndrome toxin-1 (TSST-1) and other enterotoxins. We describe the first case of the toxic shock syndrome associated with a coagulase-negative staphylococcal species, S. lugdunensis.
A 33-year-old, otherwise healthy woman developed nausea, vomiting, diffuse abdominal pain, myalgias, and confusion within 48 hours of tooth extraction and Gelfoam packing (Pharmacia-Upjohn, Kalamazoo, Michigan). Evaluation in the emergency department revealed a faint erythematous macular rash of the chest and livedo reticularis of the legs. General and pelvic examination were otherwise normal. Admission data (Table 1) fulfilled the criteria for the toxic shock syndrome. Cultures of blood and purulant right maxillary sinus aspirate showed coagulase-negative staphylococcal species, and the species of the blood isolates was identified S. lugdunensis. Tests for coagulase, TSST-1, staphylococcal enterotoxins A to E, and exfoliatin toxin A were negative. No S. aureus or S. pyogenes were isolated from blood, urine, sputum, or sinus or vaginal secretions. The patient improved with medical treatment. Desquamation of the palms and soles was noted before discharge.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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