Gram positive bullous toxic shock syndrome. The intraepidermal separation as a sign of toxin effect

被引:2
作者
Buslau, M
Biermann, H
Shah, PM
机构
[1] UNIV FRANKFURT,ZENTRUM DERMATOL & VENEROL,D-6000 FRANKFURT,GERMANY
[2] UNIV FRANKFURT,ZENTRUM INNEREN MED,D-6000 FRANKFURT,GERMANY
来源
HAUTARZT | 1996年 / 47卷 / 10期
关键词
toxic shock syndrome; grampositive sepsis; bullae; Tzanck test; frozen-section biopsy;
D O I
10.1007/s001050050510
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
A fourteen-year-old girl with acute otitis media died from gram positive sepsis and toxic shock despite intensive treatment. The definitive bacteriological results showed positive cultures for both S. aureus and S. pyogenes serotype A. In vitro the bacteria produced the bacterial superantigens TSST-1, enterotoxin A, enterotoxin C (S. aureus) and erythrogenic toxin C (S. pyogenes). The patient presented with large flaccid sterile bullae on her chest and arms as well as necrotizing fasciitis. Tzanck test showed keratinozytes without necrosis and no inflammatory cells. Frozen-section and conventional skin biopsy specimens revealed subcorneal intraepidermal cleavage. These cytological and histological findings are those staphylococcal scalded skin syndrome (SSSS) and differ from bullous erysipelas or toxic epidermal necrolysis (TEN). Therefore bacterial exotoxins are most likely responsible for the intraepidermal blistering in our case just as in SSSS. Bullae are an unfavorable prognostic sign in gram positive toxic shock syndrome. Both Tzanck test and frozen-section biopsy are easy to perform and useful in the early and rapid recognition of gram positive bullous toxic shock syndrome.
引用
收藏
页码:783 / 789
页数:9
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