1. Clindamycin can suppress Staphylococcal toxin production
Toxic shock syndrome results from the ability of bacterial toxins, usually TSST-1 in Staphylococcal disease, to act as superantigens, stimulating immune-cell expansion and rampant cytokine expression (2). A repetitive cycle of cell stimulation and cytokine release results in a cytokine avalanche that causes tissue damage, disseminated intravascular coagulation, and organ dysfunction. About 50% of cases are menstrual and 50% non-menstrual from surgical site infections, sinusitis, post-influenza pneumonia, etc. Therapy consists of administration on antimicrobial agents including drugs capable of suppressing toxin production (e.g., clindamycin, linezolid). Intravenous immunoglobulin has the potential to neutralize superantigen and to mitigate subsequent tissue damage.
Our patient did recover with administration of nafcillin, vancomycin, clindamycin and IVIG. However, he did develop skin desquamation about 2 weeks after his initial event (Figure 3).
Figure 3. Photography of patient's foot showing skin desquamation.
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