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Article in Japanese

A case of atypical neonatal toxic shock syndrome-like erythematous disease with no rash and a high CRP level at onset

Yoshimasa OKUBO1),Ryouichi BAN1),Seigo HIRA1), Satoru OGAWA1), Akira ASHIDA2)

Neonatal toxic shock syndrome (TSS) -like erythematous disease (NTED) is a neonatal infectious disease caused by an exotoxin, TSS toxin-1 (TSST-1), produced by staphylococcus bacteria and functioning as a superantigen. The main symptoms of NTED are rash, fever, and thrombocytopenia. We report a case of NTED that was considered atypical with no rash and a high C-reactive protein (CRP) level at onset caused by methicillin- sensitive Staphylococcus aureus (MSSA). The patient was a female neonate with a gestational age 40 weeks and 5 days and birth weight of 2,614g. She had a fever of 38.6 ℃ and was transferred to our department at 3 days old. Blood tests showed a high CRP level (9.0 mg/dL) and thrombocytopenia (platelet count: 120,000/μL), which were reminiscent of bacteremia. This patient received a diagnosis of NTED because a systemic rash appeared at 4 days old; MSSA was isolated from skin culture of the old umbilical region; and TSST-1, TCRVβ2, and CD45RO revealed positivity. It is necessary to consider NTED, even in cases with no rash observed at the onset and a high CRP level, which are considered to indicate bacteremia.

1)Department of Pediatrics, Saiseikai Suita Hospital
2)Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital

Key words neonatal TSS-like erythematous disease, rash, high C-reactive protein level
Received October 19, 2021
Accepted May 9, 2022

34 (2):130─136,2022