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Article in Japanese

A case report of probable toxic shock syndrome caused by SEA-producing Methicillin-susceptible Staphylococcus aureus

Masamichi ASAZUMA1,2), Kazutaka OUCHI1,3), Utsuki MATSUMURA1), Yoshihiro TAURA1,4), Takashi MORITA1), Osamu OTABE1), Hisato ITO1), Naohisa FUJITA5)

Toxic shock syndrome (TSS) is caused by cytokines-induced by superantigens which are produced by Gram-positive cocci. It is a serious disease that results in shock. Atypical cases that do not satisfy the standard criteria required for the diagnosis of the disease are classified as probable TSS. A nine-year-old boy came to the hospital for a consultation with fever and generalized rash. He had a subcutaneous induration in his right hypochondrium one week prior. An abscess was identified within the subcutaneous induration in the right hypochondrium. Gram-positive cocci, suspected to be Staphylococcus aureus, were detected in the pus which was aspirated and cultured prior to initiation of treatment. It was later confirmed to be methicillin-susceptible Staphylococcus aureus (MSSA). A bacteriological examination showed this to be a strain that produced staphylococcal enterotoxin A, which is a superantigen. Therefore, a diagnosis of probable TSS caused by MSSA soft tissue infection was made. This case suggests that probable TSS can arise even from community-acquired SEA-producing MSSA infections.

1) Department of Pediatrics, Kyoto Chubu Medical Center
2) Department of Pediatrics, Matsushita Memorial Hospital
3) Department of Pediatrics, Ayabe City Hospital
4) Department of Pediatrics, Kyoto Prefectural University of Medicine
5) Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine

Key words methicillin-susceptible Staphylococcus aureus, toxic shock syndrome, superantigen
Received September 27, 2018
Accepted June 11, 2019

31 (3):287─292,2019