Sunburn Without Sun, Shock Without a Source - Dermatology clinical simulation case. A 19-year-old female college student brought in by ambulance from her...
A 19-year-old female college student brought in by ambulance from her dormitory with abrupt-onset high fever, diffuse scarlatiniform erythroderma, conjunctival injection, and hypotension. She has been menstruating and using superabsorbent tampons. On examination, she is confused, febrile to 40.1°C, tachycardic, and hypotensive with diffuse macular erythema suggestive of toxic shock syndrome.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
Triage Recognition and Source Identification
Empiric Antimicrobial Selection and Antitoxin Therapy
Multiorgan Surveillance and ICU Disposition
Definitive Source Eradication and Patient Counseling
High-Yield Clinical Pearls
Menstrual TSS is a CDC-reportable toxin-mediated shock syndrome caused by Staphylococcus aureus superantigen TSST-1 absorbed through the vaginal mucosa.
The cardinal clinical pentad is fever, scarlatiniform rash, desquamation (late), hypotension, and multiorgan failure involving three or more organ systems.
Clindamycin must be added to bactericidal agents because it suppresses exotoxin production and modulates the superantigen-driven cytokine storm.
Tampon removal is bedside and time-critical; do not delay for specialist consultation before source control.
Anticipate fine desquamation of palms and soles 1-2 weeks after initial presentation, a late but pathognomonic clue.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.