A 60-year-old man was injured by flame burn on his hands and legs, after explosion of the lacquer- can which he handled at his work place. The dermal wound affected 10% of his body surface area. On day 3 of injury, he developed diarrhea and high fever, and fell into septic shock. The patient was treated for shock with fluid resuscitation and administered catecholamine. Renal replacement therapy was also initiated for acute kidney injury. Gram-positive cocci were cultured from his wound exudate and blood samples. He was diagnosed with toxic shock syndrome (TSS), and was administered Daptomycin, recombinant Thrombomodulin, Antithrombin and intravenous immunoglobulins (IV-IG). These therapies were effective. As pancytopenia appeared on day 11 of injury, we performed bone marrow analysis by aspiration. The bone marrow analysis indicated that the patient had developed Hemophagocytic Lymphohistiocytosis (HLH). We administered IV-IG and Corticosteroid, which were effective. TSS and HLH have a similar in onset mechanism, i.e. the immunological hyper-response to septic stress. However, there are few publications of cases associated with TSS and HLH either simultaneously or sequentially. This clinical report discusses the relationship among burn, TSS and HLH.

 

Toxic shock syndrome (TSS), Hemophagocytosis, Burn wounds, Staphylococcus Aureus