Correct!
1. He likely has a drug reaction and his antibiotics should be stopped

The physical findings of a discharge and blood coming from his nares suggest a possible sinusitis. This was confirmed by CT scan (Figure 2).

Figure 2. CT scan of sinuses showing an air-fluid level in the left maxillary sinus (arrow).

The erythroderma is a second clue on physical examination. In this setting it suggests possible toxic shock syndrome secondary to Staphylococcal or Streptococcal disease. Toxic shock syndrome results when bacteria release toxins which result in an acute multi-system disease often accompanied by multi-system organ failure (2). Major criteria for toxic shock syndrome are listed in table 1.

Table 1. Criteria for toxic shock syndrome.

• Fever >102º F.
• Hypotension
• Erythroderma
• Desquamation (1-3 weeks later)
• >3 organs involved (GI-diarrhea, muscles, mucous membranes, renal, hepatic enzymes, thrombocytopenia, CNS effects)
• Blood cultures negative (may be positive with Staphylococcal disease)

Which of the following statements are true regarding toxic shock syndrome? (Click on the correct answer to proceed to the next panel)

1. Clindamycin can suppress Staphylococcal toxin production
2. High dose intravenous immunoglobin (IVIG) has been shown to not be beneficial
3. The vast majority of cases are menstrually associated
4. Treatment with antibiotics is without benefit
5. All of the above

Home/Critical Care