Staphylococcal enterotoxin B- and lipopolysaccharide-induced toxic shock syndrome in a burn patient

Osamu Yamasaki, Satoru Sugihara, Ai Kajita, Emi Yokoyama, Tomoko Miyake, Yoji Hirai, Shin Morizane

Research output: Contribution to journalArticlepeer-review


Toxic shock syndrome (TSS) is caused by toxic shock syndrome toxin 1 or enterotoxins secreted by Staphylococcus aureus. Lipopolysaccharide (LPS) has also been shown to play a major role in the development of sepsis. Staphylococcal superantigens and LPS operate synergistically in conditioning cytokine release and lethal shock in mice. An 80-year-old woman was admitted because of a 20% mixed-depth flame burn. Despite two excisions and grafts, necrotic ulcers with methicillin-resistant Staphylococcus aureus (MRSA) colonization remained. On the 7th day after the operation, she developed shock with an erythematous rash. Blood examination revealed evidence of disseminated intravascular coagulation, and liver and renal dysfunction. A blood culture revealed a staphylococcal enterotoxin B (SEB)-producing strain of MRSA and Klebsiella pneumoniae. The septic symptoms were prolonged, but the condition gradually improved with extensive treatment. T-cell receptor analysis demonstrated a marked accumulation of SEB-mediated Vβ T cells. Stimulation of peripheral blood mononuclear cells in the recovery phase with SEB and LPS induced additive effects on tumor necrosis factor-α, interferon-γ, and interleukin-6 production. Although the present case did not fulfill the clinical criteria for TSS, the additive effects of SEB and LPS might have caused the severe septic shock.

Original languageEnglish
Pages (from-to)547-550
Number of pages4
JournalJournal of Dermatology
Issue number4
Publication statusPublished - Apr 2021


  • Klebsiella pneumonia
  • Staphylococcus aureus
  • lipopolysaccharide
  • staphylococcal enterotoxin B
  • toxic shock syndrome

ASJC Scopus subject areas

  • Dermatology


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