Prolonged course of toxic shock syndrome associated with methicillin-resistant Staphylococcus aureus enterotoxins G and I

Toxic shock syndrome (TSS), which may be hfe-threatening, is defined by clinical and laboratory evidence of fever, rash, hypotension, and multisystem abnormalities in the absence of other causes. Most cases are nonmenstrual in origin. I-* Whereas Staphylococcus aureus TSS toxin-l causes the vast majority of menstrual cases, it causes only about half of other cases.” Staphylococcal enterotoxins (SEs) were implicated in nonmenstrual TSS cases shortly after the role of TSS toxin-l was elucidated, and currently, SEs that are reported to be associated with TSS are SEs A, B, C, D, G, H, and I, with SE-B most commonly reported and SE-G and SE-I most recently reported, albeit the latter two with scant clinical details.2s4-8 The following case associated with SE-G and SE-I illustrates the consequences of these immunomodulatory pyrogenic toxin superantigens over a prolonged course, as well as pitfalls in their diagnosis and management.