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A 15 year old girl presented with a painful desquamative rash, fever, and profound hypotension. Despite antimicrobial therapy and intensive supportive measures, she died 80 hours after admission. The premortem skin biopsy and autopsy findings, which included subepidermal edema and blister formation, subacute vasculitis, and striking interstitial edema involving several organs, are consistent with a toxin mediated process. Current knowledge of the pathogenesis of the toxic shock syndrome and its differential diagnosis are discussed in light of the clinicopathologic findings in this case.
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