Toxic shock syndrome complicated by co-infection with multidrug-resistant Acinetobacter baumannii

This report describes the occurrence of toxic shock syndrome in a teenage girl. She presented with fever, rash, vomiting, dyspnoea and drowsiness. Examination showed a strawberry tongue and suppurative lymphadenitis in the right axilla with hypotensive shock. Abdominal examination confirmed hepatomegaly. Laboratory evaluation confirmed sepsis. The clinical presentation and evaluation suggested the possibility of toxic shock syndrome (TSS). Culture of her axillary lymph node abscess was positive for Acinetobacter baumannii The child was managed with supportive therapy including high flow oxygen, fluid resuscitation, inotropes and antibiotics. She recovered within a week and was reviewed 1 week later. She was found to have skin desquamation on her palms and soles. TSS should be considered in the differential diagnosis in a child presenting with fever, rash and hypotension. It requires thorough examination and evaluation to identify the condition and focus of infection and prompt aggressive management which can bring best outcomes.