1/8. Fulminant purpuric rash.We report on a fatal case of purpura fulminans caused by severe meningococcaemia. Despite early and aggressive treatment with the use of a specific algorithm and the maintenance of a stable haemodynamic status in the first hour since admission, purpura fulminans developed impressively over a few minutes. Necropsy showed microvascular thrombosis in the dermis but not in visceral organs, suggesting the diagnosis of meningococcal septic shock with purpura fulminans limited to the skin. Acquired deficiency of protein c, which exerts anticoagulant and antiinflammatory functions, is the central mechanism ultimately responsible for purpura fulminans. The disorder predicts a poor outcome of meningococcaemia and early and aggressive resuscitation is recommended in the emergency department with antibiotics, volume expansion, inotropic drugs, and protein c replacement. An attitude of scepticism is appropriate in the management of these patients even when early resuscitation is successful and haemodynamic parameters remain stable.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
2/8. Two men with toxic shock syndrome presenting with targetoid and spotty skin rashes.Two previously healthy men who presented with hypotension, constitutional symptoms, and targetoid and discrete spotty erythematous plaques were diagnosed with toxic shock syndrome based on histopathological findings. Specifically, their biopsies revealed necrotic keratinocytes, neutrophils in the epidermis, and neutrophils surrounding dilated superficial vessels. In one case, the diagnosis of toxic shock syndrome was confirmed with rising titers to toxic shock syndrome toxin-1. Both patients recovered with supportive care and clindamycin administration. We suggest that patients with fever, hypotension, constitutional symptoms and rash should be started on clindamycin and have a skin biopsy as part of their initial evaluation. An understanding that toxic shock syndrome can strike anyone has manifold dermatological manifestations and defined histopathological findings is important for its early diagnosis and effective treatment.- - - - - - - - - - ranking = 244.18226097485keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
3/8. Staphylococcal exanthematous disease in a newborn due to a virulent methicillin-resistant staphylococcus aureus strain containing the TSST-1 gene in europe: an alert for neonatologists.We report a case of staphylococcal exanthematous disease in a newborn due to a toxic shock syndrome toxin 1- and SEC-producing methicillin-resistant staphylococcus aureus strain and alert neonatologists to the probable emergence in france of the neonatal toxic shock syndrome-like exanthematous disease in newborns previously described in japan. We advise neonatologists to pay careful attention to clinical parameters and to prescribe appropriate tests: platelet count, serum c-reactive protein concentration, and Vbeta2-positive T-cell counts.- - - - - - - - - - ranking = 61.045565243712keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
4/8. Ilio-psoas abscess caused by methicillin-resistant staphylococcus aureus (MRSA): a rare but potentially dangerous condition in neonates.We report a case of methicillin-resistant staphylococcus aureus ilio-psoas abscess (IPA) in a neonate. This case has clinical importance because this neonate had toxic shock syndrome-like exanthematous disease, known as NTED, before developing IPA. A high index of suspicion is required for IPA if a neonate presents with limb disuse and fever of unknown origin. Our case required surgical drainage, since ultrasound-guided percutaneous needle aspiration failed.- - - - - - - - - - ranking = 30.522782621856keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
5/8. An idiopathic skin eruption resembling a butterfly rash in a septic patient with disseminated intravascular coagulation following bone marrow transplantation.A 31-year-old man who underwent chemotherapy and bone marrow transplantation to treat acute myeloblastic leukemia was admitted to our department complaining of high fever and hypotension. His physical examination revealed warm shock state, eruptions resembling that seen in systemic lupus erythematosus on his face and cyanosis in his fingers. We diagnosed septic shock and idiopathic skin eruption on his face. Following treatment with blood transfusion, anticoagulant, antibiotics, respirator and continuous arteriovenous hemofiltration and dialysis, the patient's condition gradually improved. The eruptions on his face first observed at admission progressed with a worsening of his disseminated intravascular coagulation (DIC), and subsided with an improvement in his DIC. A biopsy of the eruption was taken and pathological findings of the eruption revealed multiple micro-fibrin depositions of the dermis. The skin necrosis in purpura fulminans often begins in the distal extremities. But our patient developed this uncommon skin eruption on his face. patients with an idiopathic skin eruption resembling a butterfly rash in a septic patient should be considered to complicate DIC as in the present case.- - - - - - - - - - ranking = 2keywords = shock (Clic here for more details about this article) |
6/8. Acute respiratory distress syndrome in a child with Kawasaki disease.This report presents a case of classic Kawasaki disease with progression to acute respiratory distress syndrome. The severity of the patient's pulmonary disease led clinicians to suspect toxic shock syndrome. Clinicians need to be aware that pulmonary manifestations of Kawasaki disease can include acute respiratory distress syndrome.- - - - - - - - - - ranking = 30.522782621856keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
7/8. Streptococcal toxic shock syndrome with initial manifestation of abdominal pain and cholecystitis.Streptococcal toxic shock syndrome with the initial manifestation of abdominal pain and cholecystitis is rare. We report the case of a 10-year-old boy who presented with abdominal pain, cholecystitis and shock initially. Acute respiratory distress syndrome, renal and hepatic insufficiency and disseminated intravascular coagulation developed soon after admission. skin rash and desquamation were found subsequently during the recovery phase. The blood and sputum cultures were sterile. Acute and convalescent plasma from the patient showed increased anti-streptolysin O titer (ASLO titer). Measurement of the ASLO titer on Day 11 after the onset of disease had an ASLO titer of 242 IU/ml (N latex ASL, Dade Behring Marburg GmbH, USA), and the ASLO titer on Day 21 after the onset of disease showed an increase to 875 IU/ml. These clinical findings and the plasma analysis were consistent with streptococcal toxic shock syndrome.- - - - - - - - - - ranking = 184.13669573114keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
8/8. A case of anaphylactic shock possibly caused by intravesical Hexvix.BACKGROUND: We report a case of a 69-year-old Caucasian male who experienced a severe drop in blood pressure and a skin rash after fluorescence cystoscopy and transurethral resection of the prostate. The diagnostic agent used for fluorescence cystoscopy and suspected of causing the anaphylaxis was hexaminolevulinate hydrochloride (Hexvix). INCIDENT: A profound fall in blood pressure associated with atrial fibrillation, the appearance of a rash, vomiting and transient loss of consciousness occurred immediately after surgery. The hypotension persisted for several hours despite intensive treatment. The reaction commenced approximately 5 h after exposure to Hexvix. There was an increase in serum tryptase (almost nine-fold) and a positive skin prick test to undiluted Hexvix. CONCLUSION: The mechanism of the anaphylaxis is uncertain, but is considered likely to be a non-immunoglobulin e-mediated allergic reaction possibly caused by Hexvix. This is the first reported case of a severe allergic reaction after intravesical instillation of Hexvix.- - - - - - - - - - ranking = 4keywords = shock (Clic here for more details about this article) |