A 16-year-old girl develops high fever (39.5 degrees C), vomiting, myalgia, hypotension (BP 84/50 mmHg), and a diffuse sunburn-like erythema during menses while using a high-absorbency tampon. Blood cultures are negative. Two weeks later her palms and soles peel. The most likely causative organism and toxin is:

• A Streptococcus pyogenes producing streptolysin O
• B Neisseria meningitidis producing endotoxin
• C Pseudomonas aeruginosa producing exotoxin A
• D Staphylococcus aureus producing TSST-1 ✓

Explanation

Menstrual toxic shock syndrome follows Staphylococcus aureus colonization of superabsorbent tampons, where TSST-1 acts as a superantigen causing massive cytokine release. Features include abrupt fever above 38.9 degrees C, hypotension, diffuse erythroderma, multiorgan involvement, negative blood cultures (toxin mediated), and characteristic desquamation of palms and soles 1 to 2 weeks later. Management includes removing the tampon, aggressive fluids, clindamycin to suppress toxin synthesis plus an antistaphylococcal agent.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.