From: RS3PE syndrome developing during the course of probable toxic shock syndrome: a case report
Definite TSS (all criteria must be present) [6] | |
Clinical Criteria | |
An illness with the following clinical manifestations: | |
・Fever: temperature greater than or equal to 102.0 °F (greater than or equal to 38.9 °C) | |
・Rash: diffuse macular erythroderma | |
・Desquamation: 1–2 weeks after onset of rash | |
・Hypotension: systolic blood pressure less than or equal to 90 mmHg for adults or less than the fifth percentile by age for children aged less than 16 years | |
・Multisystem involvement (three or more of the following organ systems): | |
✓ Gastrointestinal: vomiting or diarrhea at onset of illness | |
✓ Muscular: severe myalgia or creatine phosphokinase level at least twice the upper limit of normal | |
✓ Mucous membrane: vaginal, oropharyngeal, or conjunctival hyperemia | |
✓ Renal: blood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria (greater than or equal to 5 leukocytes per high-power field) in the absence of urinary tract infection | |
✓ Hepatic: total bilirubin, alanine aminotransferase enzyme, or aspartate aminotransferase enzyme levels at least twice the upper limit of normal for laboratory | |
✓ Hematologic: platelets less than 100,000/mm3 | |
✓ Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent | |
Laboratory Criteria for Diagnosis | |
Negative results on the following tests, if obtained: | |
・Blood or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus) | |
・Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles | |
Probable TSS (≥3 criteria and desquamation or ≥ 5 criteria without desquamation) [7] | |
・Temperature ≥ 38.9 °C | |
・Rash | |
・Hypotension, orthostatic dizziness, or syncope | |
・Myalgia | |
・Vomiting, diarrhea, or both | |
・Mucous membrane inflammation (conjunctivitis, pharyngitis, vaginitis) | |
・Clinical or laboratory abnormalities of ≥2 organ systems | |
・Reasonable evidence for absence of other etiologies |