Toxic shock syndrome physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

Patients with toxic shock syndrome (TSS) usually present with shock. Physical examination of patients with TSS is usually remarkable for hypotension, fever, and diffuse erythroderma. The presence of desquamation on physical examination is highly suggestive of TSS.

Physical exam in TSS patients usually include these findings:^[1][2][3]

• TSS is presented by its shock symptoms.
• May be ill appearing in the early stages of the disease, progress to confusion and change in mental status by disease progress.

• High grade Fever
• Hypotension
  • Systolic blood pressure of ≤90 mmHg for adults or less than fifth percentile by age for children <16 years of age, which may be unresponsive to fluid infusion even large amounts of isotonic intravenous fluids
• Tachycardia
  • As a result of shock and hypotension
• Tachypnea
  • May be pressent as a result of pulmonary edema secondary to shock

• Diffuse pruritic maculopapular rash with palm and soles desquamation
• Erythroderma
• Superficial ulcerations
• Petechiae
• Vesicles
• Bullae (specially in Streptococcal TSS)
• Skin desquamation (apears weeks after disease onset)
• Non-pitting edema
• Hair and nail loss

• Cyanosis

• Ophthalmoscopic exam may be abnormal with findings of conjunctival–scleral hemorrhage
• Hyperemia of oropharyngeal mucosa

• Wet rales due to pulmonary edema complication

• Possibly a diastolic gallop (S3) due to pulmonary edema

• Non-pitting edema
  • Can develop as a result of increases in interstitial fluid

• Patient is usually oriented but if the disease is not diagnosed, it can lead to altered mental status and confusion
• Hyporeflexia can be seen as a result of associated hypocalcemia/ hypophosphatemia
• Muscle cramps (as a result of hypocalcemia, a contributing complication of renal failure)
• Seizure

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