Toxic shock: clinical presentation and management. II

The management of toxic shock syndrome poses a challenge to clinicians because the syndrome has only been recently recognized and new complications are still being described. This report describes the major complications which arose in our case and highlights a severe bleeding disorder which was the cause of the patient's death. The bleeding disorder was characterized by normal in vitro coagulation screens, normal platelet aggregation tests, but prolonged skin bleeding time. It was not improved by haemodialysis, platelet transfusion or steroid therapy. We conclude that in cases with severe toxaemia, despite early recognition and appropriate treatment, there is still no effective method of preventing complications. Current avenues for investigation include plasmapheresis, the administration of fresh frozen plasma, and the development of a specific anti-toxin.