Un quadro clinico a cavallo fra sindrome dello shock tossico e malattia di Kawasaki: descrizione di un caso

Toxic shock syndrome (TSS) is a multiorgan failure disease with a sudden onset, fever, rash followed by desquamation, vomiting and diarrhea, hypotension, myalgia, mental confusion, conjunctivitis and strawberry tongue. It is caused by toxin-producing strains of Staphylococci and Streptococci. These toxins act as “superantigens” inducing an aspecific activation and expansion of V-b2+ T cells. TSS has clinical and immunologic similarities with Kawasaki disease (KD). The differential diagnosis between these syndromes is often difficult. Overlap syndromes between TSS and KD have been described and there are several case reports of dramatic clinical improvement in patients with TSS following administration of high dose of IVIG. We report a case of a 11 years old girl affected by an overlap syndrome between TSS and KD, probably triggered by a localized cutaneous streptococcal infection, that promptly improved after high dose of IVIG.