{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:10:04Z","timestamp":1756318204032,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,6,9]]},"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:p>We herein describe an irregular case of toxic-shock syndrome (TSS). A previously healthy 28-year-old Japanese man developed a sudden-onset high fever. The patient was suffering from conjunctival hyperaemia, gastrointestinal symptoms such as vomiting and diarrhoea, and systemically diffused macular erythroderma. Further physical examination detected pustules on his back, which self-destructed over time. Laboratory revealed multiple organ failures. Subsequently, scalded skin on the face and desquamation in the limb extremities emerged by day 10, leading to the diagnosis of TSS, despite his stable circulatory dynamics through the course. Learning points for clinicians include that they should recall TSS as a possible disease concurrently causing high fever, systemic rash and multiple organ dysfunctions, even without being in a state of shock. The characteristic desquamations emerged in the limb extremities after hospitalisation were of help in diagnosing TSS.<\/jats:p>","DOI":"10.1136\/bcr-2019-229610","type":"journal-article","created":{"date-parts":[[2019,6,29]],"date-time":"2019-06-29T12:54:08Z","timestamp":1561812848000},"page":"e229610","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pustules on the back possibly triggering toxic-shock syndrome"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5086-1891","authenticated-orcid":false,"given":"Hideharu","family":"Hagiya","sequence":"first","affiliation":[{"name":"Department of General Internal Medicine, Osaka University Hospital, Suita, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Futoshi","family":"Nakagami","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Osaka University Hospital, Suita, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Minami","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Saiseikai Senri Hospital, Suia, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Terada","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Saiseikai Senri Hospital, Suia, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,6,29]]},"reference":[{"key":"2025082710563054000_12.6.e229610.1","doi-asserted-by":"crossref","first-page":"S147","DOI":"10.1016\/S0163-4453(17)30206-2","article-title":"Toxic shock syndrome - the seven Rs of management and treatment","volume":"74","author":"Wilkins","year":"2017","journal-title":"J Infect"},{"key":"2025082710563054000_12.6.e229610.2","unstructured":"Centers for Disease Control and Prevention. Toxic Shock Syndrome (Other Than Streptococcal) (TSS) 2011 Case Definition. 2011 https:\/\/wwwn.cdc.gov\/nndss\/conditions\/toxic-shock-syndrome-other-than-streptococcal\/case-definition\/2011\/."},{"key":"2025082710563054000_12.6.e229610.3","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2015-209635"},{"key":"2025082710563054000_12.6.e229610.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0022997","article-title":"Staphylococcal toxic shock syndrome 2000-2006: epidemiology, clinical features, and molecular characteristics","volume":"6","author":"DeVries","year":"2011","journal-title":"PLoS One"},{"key":"2025082710563054000_12.6.e229610.5","first-page":"225","article-title":"Adult-onset Kawasaki disease (mucocutaneous lymph node syndrome) and concurrent Coxsackievirus A4 infection: a case report","volume":"8","author":"Ueda","year":"2015","journal-title":"Int Med Case Rep J"},{"key":"2025082710563054000_12.6.e229610.6","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2249.2002.01805.x"},{"key":"2025082710563054000_12.6.e229610.7","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.nmni.2015.08.002","article-title":"Unusual staphylococcal toxic shock syndrome presenting as a scarlet-like fever","volume":"8","author":"Andrey","year":"2015","journal-title":"New Microbes New Infect"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-229610","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:56:39Z","timestamp":1756317399000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-229610"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6]]},"references-count":7,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,6,29]]},"published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1136\/bcr-2019-229610"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-229610","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,6]]}}}