Title : Bullous cutaneous presentation of toxic shock syndrome in an immunocompromised adolescent
Abstract:
Introduction: Toxic shock syndrome (TSS) is a rare, life-threatening illness caused by toxin-producing Staphylococcus aureus or Streptococcus pyogenes. Bullous cutaneous manifestations are uncommon and may resemble autoimmune blistering diseases, leading to delayed recognition.
Case Report: A 17-year-old female with systemic lupus erythematosus and chronic venous thrombosis presented with fever, hypotension, and multiple tense bullae on the lower limb. She rapidly developed septic shock and acute kidney injury (KDIGO IV), requiring intensive care, vasopressors, and renal replacement therapy. Blood cultures grew Staphylococcus aureus. Endovascular thrombolysis and broad-spectrum antibiotics achieved gradual improvement. Palmar and plantar desquamation appeared during recovery.
Discussion: Bullous lesions in TSS are uncommon but may serve as a diagnostic clue, particularly in immunocompromised hosts. Differentiating this presentation from autoimmune or druginduced dermatoses is crucial for timely management.
Conclusion: TSS should be suspected in patients presenting with fever, rash, and hemodynamic instability, especially those who are immunocompromised. Recognition of atypical bullous forms facilitates early intervention and improved outcomes.
Keywords: toxic shock syndrome, bullous eruption, pediatric dermatology,immunocompromised host, Staphylococcus aureus infection
