{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T06:17:21Z","timestamp":1778566641937,"version":"3.51.4"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Toxic shock syndrome (TSS) is a rare but potentially life-threatening toxin-mediated infection. Cases associated with Panton-Valentine leukocidin (PVL)-producing\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      are particularly uncommon in clinical settings and remain insufficiently documented in the literature.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      This report aims to strengthen clinical understanding of TSS caused by methicillin-sensitive\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (MSSA) harboring PVL, assess optimal antimicrobial strategies for treating MSSA infections, minimize the risk of therapeutic failure, and offer insights that may inform timely diagnosis and effective clinical management.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We present a case involving a 26-year-old female patient with MSSA isolated from multiple anatomical sites who initially received vancomycin before being diagnosed with PVL-positive MSSA-induced TSS. Therapeutic efficacy was evaluated by integrating her clinical course with contemporary evidence on the management of severe MSSA infections. In addition, treatment considerations for highly virulent MSSA infections with distinct clinical characteristics were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patient\u2019s clinical course enabled a comparative assessment of \u03b2-lactam antibiotics, such as cefazolin, versus glycopeptide agents, such as vancomycin, in the management of MSSA infections. Upon confirmation of MSSA, early transition to targeted therapy with cefazolin or anti-staphylococcal penicillins may be considered. In critically ill patients, early virulence gene testing is important for rapid identification of PVL-positive strains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PVL-positive MSSA may be associated with a fulminant, atypical toxic shock syndrome-like phenotype characterized by disseminated pustulosis and pancytopenia, which should raise immediate suspicion of a toxin-driven process. This case suggests that de-escalation from vancomycin to a \u03b2-lactam antibiotic upon MSSA confirmation may be a key therapeutic strategy. Increased vigilance, rapid virulence factor testing, and early aggressive management are important to improving outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1805801","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T05:44:20Z","timestamp":1778564660000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fatal Panton-Valentine leukocidin-positive MSSA toxic shock syndrome: a call for rapid virulence detection and optimized antimicrobial therapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Congcong","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]},{"name":"Department of Pharmacy, The First People\u2019s Hospital of Xiangtan City","place":["Xiangtan, Hunan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rongrong","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]},{"name":"College of Pharmacy, Dalian Medical University","place":["Dalian, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingxian","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Na","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lixia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins15010038","article-title":"The effect of ascorbic acid and nicotinamide on Panton-Valentine leukocidin cytotoxicity: An ex vivo study","volume":"15","author":"AlSaleh","year":"2023","journal-title":"Toxins (Basel)"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13010096","article-title":"Toxic shock syndrome: A literature review","volume":"13","author":"AtChade","year":"2024","journal-title":"Antibiotics"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2026.1729510","article-title":"Case report: Fulminant shock due to PVL-positive Staphylococcus aureus in an adolescent\u2014superantigen-negative sepsis with toxic shock-like features","volume":"13","author":"Attou","year":"2026","journal-title":"Front. 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