Recurrent nonmenstrual toxic shock syndrome: Clinical manifestations, diagnosis, and treatment

We report 3 cases of recurrent nonmenstrual toxic shock syndrome (TSS) and review the clinical manifestations, diagnosis, and treatment. The primary s ites of infection were the genital tract (in a patient who underwent cesare an delivery), the upper respiratory tract, and a breast abscess. In all 3 p atients, the initial illness was not recognized to be TSS; only after devel opment of recurrent illness with desquamation was this diagnosis entertaine d. Strains of Staphylococcus aureus that were isolated from 2 patients prod uced TSS toxin-1, whereas the third strain produced staphylococcal enteroto xin B. All 3 patients lacked antibody to the implicated toxins at the time of presentation with recurrent illness. Nonmenstrual TSS can occur in a var iety of clinical settings and may be recurrent. The presence of desquamatio n during a febrile, multisystem illness could suggest this diagnosis and sh ould prompt the clinician to obtain appropriate cultures for S. aureus.