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Pustules on the back possibly triggering toxic-shock syndrome
  1. Hideharu Hagiya1,
  2. Futoshi Nakagami1,
  3. Yuki Minami2 and
  4. Hiroaki Terada2
  1. 1 Department of General Internal Medicine, Osaka University Hospital, Suita, Japan
  2. 2 Department of General Internal Medicine, Saiseikai Senri Hospital, Suia, Japan
  1. Correspondence to Dr Hideharu Hagiya, e_dai_for_all{at}


We herein describe an irregular case of toxic-shock syndrome (TSS). A previously healthy 28-year-old Japanese man developed a sudden-onset high fever. The patient was suffering from conjunctival hyperaemia, gastrointestinal symptoms such as vomiting and diarrhoea, and systemically diffused macular erythroderma. Further physical examination detected pustules on his back, which self-destructed over time. Laboratory revealed multiple organ failures. Subsequently, scalded skin on the face and desquamation in the limb extremities emerged by day 10, leading to the diagnosis of TSS, despite his stable circulatory dynamics through the course. Learning points for clinicians include that they should recall TSS as a possible disease concurrently causing high fever, systemic rash and multiple organ dysfunctions, even without being in a state of shock. The characteristic desquamations emerged in the limb extremities after hospitalisation were of help in diagnosing TSS.

  • dermatology
  • general practice/family medicine

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  • Contributors HH, FN, YM and HT contributed to management of the patient. HH mainly wrote the manuscript.

  • 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.

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

  • Patient consent for publication Obtained.