Cutaneous pathology in toxic shock syndrome.

The pathologic findings in the skin in a new case of toxic shock syndrome (TSS) are detailed and are discussed in view of previously reported data on TSS in the literature. Necrolysis of keratinocytes at different levels of the epidermis in combination with a predominantly perivascular lymphocytic infiltrate were characteristic features in lesional skin biopsy specimens obtained 5 days after the onset of acute illness and during the development of erythroderma with purpura and diffuse intravasal coagulation. Prominent vascular changes in the skin, which have not been reported before in TSS, were excited endothelial cells in combination with the presence of thrombi in the superficial capillaries. Histopathologic investigations of the dermatitis in TSS can be helpful in differentiating this syndrome from other acute toxic skin eruptions.