RECURRENT TOXIN-MEDIATED PERINEAL ERYTHEMA

Background: Important new diseases due to bacterial toxins functioning as superantigens have been described with increasing frequency within recent years. Toxic shock syndrome, recalcitrant erythematous desquam ating disorder, streptococcal toxic shock-like syndrome, and, most rec ently, mucocutaneous lymph node syndrome (Kawasaki disease) have been etiologically linked with certain staphylococcal and streptococcal tox ins. We describe two patients with a novel clinical presentation of to xin-mediated disease, which shares certain clinical features with muco cutaneous lymph node syndrome. Observations: Two otherwise healthy you ng male adults developed recurrent erysipelaslike perineal erythema, w hich regularly erupted within 1 to 2 days of the onset of acute pharyn gitis. Accompanying signs included mucosal changes and acral erythema with desquamation. Throat cultures obtained during the acute episodes yielded toxin-producing Staphylococcus aureus from one patient and tox in-producing Streptococcus pyogenes from the other. Conclusion: The re current nature, age predilection, and clinical presentation suggest th at our patients display a unique clinical syndrome due to toxin-produc ing bacteria.