Staphyloccocal toxic shock syndrome in a child with acute lymphoblastic leukaemia

Toxic shock syndrome (TSS) is toxaemia, characterised by fever, rash hypotension, constitutional symptoms and multiorgan involvement. The TSS Toxin-1 (TSST-1) that is responsible for the syndrome is elaborated by Staphylococcus aureus (S. aureus). The disease may become fulminant and fatal in immunocompromised patients. We report a case in a 4 1/2 years old girl with acute lymphoblastic leukaemia on treatment but in remission. She was admitted to hospital with neutropenia and herpetic stomatitis. In hospital she became pyrexial with signs of a tunnel infection at the central line site. She developed cardiogenic shock, multiple organ failure and died within 12 hours after the onset of the infection. Blood cultures taken at the onset of the febrile episode grew S. aureus, which produced TSST-1. Physicians treating immunocompromised patients should be aware of the precipitous presentation of this syndrome with its fulminant nature. Early diagnosis and appropriate treatment is needed.