Teenage boy with high fever and rash: what could we be missing?

A 15-year-old boy was admitted to a local hospital with high fever, generalised rash and a mild sore throat. He was started on intravenous flucloxacillin and 12 hours later develops a sustained low diastolic blood pressure (DBP), unresponsive to fluid volume expansion and cardiovascular support with dopamine. Intravenous clindamycin was added and transportation to paediatric intensive care unit arranged. Dopamine dosing was increased and norepinephrine infusion was added subsequently with immediate stabilisation of DBP. A sacrococcygeal pilonidal abscess was identified, requiring prompt surgical drainage. The microbiological culture of abscess material was positive for an enterotoxin-producing Staphylococcus aureus and Peptostreptococcus magnus. He was free of symptoms after 4 days. This case report summarises a potential severe complication of the pilonidal disease.

[1]  F. Rauchfuß,et al.  [Puberty is a major factor in pilonidal sinus disease : Gender-specific investigations of case number development in Germany from 2007 until 2015]. , 2017, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[2]  M. Ardelt,et al.  Die Pubertät ist ein wichtiger Faktor bei der Pilonidalsinuserkrankung , 2017, Der Chirurg.

[3]  H. Scheuerlein,et al.  Microbiology of the infected recurrent sacrococcygeal pilonidal sinus , 2016, International wound journal.

[4]  I. Okan,et al.  Does Sacrococcygeal Angle Play a Role on Pilonidal Sinus Etiology? , 2015, Prague medical report.

[5]  S. Steele,et al.  Practice parameters for the management of pilonidal disease. , 2013, Diseases of the colon and rectum.

[6]  J. E. Wild,et al.  Persistence survey of Toxic Shock Syndrome toxin-1 producing Staphylococcus aureus and serum antibodies to this superantigen in five groups of menstruating women , 2010, BMC infectious diseases.

[7]  Anil Sunkara,et al.  Intermammary Pilonidal Sinus , 2010, International journal of trichology.

[8]  H. Çaksen,et al.  Cutaneous Manifestations in Childhood Staphylococcal Sepsis , 2002, The Journal of dermatology.

[9]  T. Herchline,et al.  Bacteremic nonmenstrual staphylococcal toxic shock syndrome associated with enterotoxins A and C. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  F. Zveibil,et al.  Toxic shock syndrome complicating neglected pilonidal abscess: a case report , 1999 .

[11]  G. Karydakis.  Easy and successful treatment of pilonidal sinus after explanation of its causative process. , 1992, The Australian and New Zealand journal of surgery.

[12]  E. Shlasko,et al.  Toxic shock syndrome after pilonidal cystectomy , 1991, Diseases of the colon and rectum.

[13]  A. Işık,et al.  Novel Approaches in Pilonidal Sinus Treatment. , 2016, Prague medical report.

[14]  Marianna Zukiwskyj.  The Associated Microbiology of pilonidal Sinus Disease in a Small Rural Hospital , 2016 .

[15]  S. Friis,et al.  [Recurrent toxic shock syndrome in a man after surgery for a pilonidal cyst]. , 1982, Ugeskrift for laeger.

[16]  C. Helms,et al.  Toxic-shock syndrome in a young man with a pilonidal abscess. , 1982, The New England journal of medicine.