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Toxic shock syndrome: the great masquerader
  1. Sagnik Biswas1,
  2. Animesh Ray1,
  3. Farhan Fazal1 and
  4. Swati Mahajan2
  1. 1 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Animesh Ray, doctoranimeshray{at}


Toxic shock syndrome is a rare but potentially lethal toxin-mediated illness that can be caused by streptococcal and staphylococcal species. It initially presents as a febrile illness that rapidly progresses to multiorgan dysfunction, hence a high index of suspicion coupled with rapid verification of the diagnosis and aggressive treatment is required to improve the outcome of the disease. A 23-year-old man presented with high-grade fever associated with headache, retro-orbital pain, gastroenteritis and gum bleeds. Treatment was initiated keeping in mind the possibility of dengue haemorrhagic fever. However, further clinical deterioration led us to re-examine our patient, revealing an old neglected wound. Microbiological confirmation of methicillin-resistant Staphylococcus aureus from the wound swab and prompt institution of appropriate treatment led to a favourable outcome in a case known to be associated with serious morbidity and mortality.

  • tropical medicine (infectious disease)
  • dermatology

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  • Contributors SB, FF and AR were involved in the case management in hospital. SB and FF were involved in compiling the article. AR has reviewed the final draft. SM was the pathologist in the treating team and has also contributed in reviewing the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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