The Journal of Pediatric Infectious Diseases and lmmunology Online Journal

Abstract

The Journal of Pediatric Infectious Diseases and Immunology > Vol.33 No.1 contents > Abstract

Article in Japanese

Sacral subcutaneous abscess presenting with neonatal toxic-shock-syndrome-like exanthematous disease

Yasuko KOBARI1), Akihiko SHIMIZU2)

Neonatal toxic-shock-syndrome-like exanthematous disease (NTED) is caused by super antigen toxin produced by Staphylococcus aureus including methicillin-resistant Staphylococcus aureus (MRSA). NTED usually is self-limited. Herein, a case of sacral subcutaneous abscess presenting with NTED-like symptoms is presented. An 8-day-old girl came to this hospital with a chief complaint of rash and fever. Thrombocytopenia and elevation of C-reactive protein were noted. Her presentation was compatible with NTED because MRSA was detected from the vaginal culture of her mother during pregnancy. Physical examination revealed redness and swelling on the sacral region, where ultrasonography revealed subcutaneous fluid accumulation. Her illness was diagnosed as cellulitis and subcutaneous abscess, and cefazolin and intravenous vancomycin were started. MRSA was detected from aspiration drainage. On the fourth day of admission, the thrombocytopenia worsened and she was transferred to a tertiary care hospital. Incision and drainage were performed, and the patient was discharged without any sequelae. The isolated strain had a tsst-1 gene, which was considered to be responsible for the thrombocytopenia and rash. Invasive MRSA infection by toxic shock syndrome toxin 1 (TSST-1) producing strain can present similar symptoms to those in NTED. Even if a neonate presents NTED-like symptoms, it is important to focus truly on detecting MRSA infection.


1) Department of Pediatrics, Isesaki Municipal Hospital
2) Department of Allergy, Infectious Diseases and Immunology, Gunma Children's Medical Center

Key words neonatal toxic-shock-syndrome-like exanthematous disease, MRSA, subcutaneous abscess, thrombocytopenia
Received June 11, 2020
Accepted December 22, 2020

33 (1):41─46,2021

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