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The symptoms and physical findings showed improvement within four days, and normalization of the laboratory data and chest x-ray film was seen by day 10 of hospitalization. Desquamation of skin over the palms and soles occurred during recovery, appearing most prominently on the soles (Fig 2). He was discharged in good health on day 12.

Discussion

There is no diagnostic test for toxic shock syndrome. Case definition requires the presence of specific clinical manifestations. The Centers for Disease Control criteria include fever, diffuse erythroderma with subsequent desquamation, hypotension, and multisystem involvement. Additionally, blood, throat, and cerebrospinal fluid cultures, as well as serologic studies for Rocky Mountain spotted fever, leptospirosis, and rubeola should be negative if obtained. Positive TSS toxin assays are not necessary for diagnosis. This case fulfills these criteria, including laboratory documentation of systemic illness with elevated creatinine, aspartate aminotransferase, alanine aminotransferase, creatine kinase and thrombocytopenia. Combining data from this patient and the 11 previously reported cases of postinfluenza TSS reveals the following points. review


Figure 2
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