Toxic shock syndrome associated with Staphylococcus aureus sinusitis in children.

Toxic shock syndrome (TSS) is a severe, acute, multisystem illness associated with rash and shock. It is usually associated with a focal infection (e.g., during menstruation associated with tampon use, abscess, surgical wound infection) caused by certain Staphylococcus aureus strains. Identification and drainage of the focus of infection may be important in therapy. Occasionally, a focus of infection is not obvious, requiring additional diagnostic procedures. Three cases of children with TSS associated with sinusitis and no other focus of S. aureus infection are presented, demonstrating the important consideration of the perinasal sinuses as a cryptic focus of S. aureus infection causing TSS.