Atypical staphylococcal toxic shock syndrome: two fatal pediatric cases

We describe two fatal pediatric cases involving toxin-producing strains of S. aureus which illustrate that adoption of the term "atypical toxic shock syndrome" may aid in the recognition and treatment of disease in cases that do not entirely satisfy current criteria at the time of presentation. The predominant feature in both these cases was an uncontrollable "capillary leak syndrome" with massive third space fluid loss resulting in the inability to maintain intravascular volume. This occurred in the absence of the typical rash in one patient and before to its development in the second.