Skin biopsy PCR enables rapid diagnosis of tattoo-associated staphylococcal toxic shock syndrome.

BACKGROUND

Staphylococcal toxic shock syndrome (TSS) is a rare but potentially fatal toxin-mediated disease. Early diagnosis is challenging because blood cultures are frequently negative and clinical manifestations may initially be nonspecific.

CASE PRESENTATION: A 29-year-old man presented with fever, diarrhoea, hypotension, and purpuric lesions localized to a calf tattoo performed three days earlier. Laboratory investigations revealed systemic inflammation, acute kidney injury, thrombocytopenia, and hepatic dysfunction. Despite negative blood cultures and cerebrospinal fluid analyses, the subsequent development of a diffuse rash raised suspicion of staphylococcal TSS. Real-time PCR performed on a skin biopsy obtained from the tattoo lesion detected Staphylococcus aureus and the toxic shock syndrome toxin-1 (TSST-1) gene, confirming the diagnosis. The patient received clindamycin combined with β-lactam therapy and experienced rapid clinical improvement, followed by characteristic desquamation.

CONCLUSIONS

This case highlights the diagnostic value of PCR testing performed on skin biopsy specimens for rapid microbiological confirmation of tattoo-associated staphylococcal TSS.