Recurrent toxin-mediated perineal erythema.
BACKGROUND
Important new diseases due to bacterial toxins functioning as superantigens have been described with increasing frequency within recent years. Toxic shock syndrome, recalcitrant erythematous desquamating disorder, streptococcal toxic shock-like syndrome, and, most recently, mucocutaneous lymph node syndrome (Kawasaki disease) have been etiologically linked with certain staphylococcal and streptococcal toxins. We describe two patients with a novel clinical presentation of toxin-mediated disease, which shares certain clinical features with mucocutaneous lymph node syndrome.


METHODS
Two otherwise healthy young male adults developed recurrent erysipelaslike perineal erythema, which regularly erupted within 1 to 2 days of the onset of acute pharyngitis. Accompanying signs included mucosal changes and acral erythema with desquamation. Throat cultures obtained during the acute episodes yielded toxin-producing Staphylococcus aureus from one patient and toxin-producing Streptococcus pyogenes from the other.


CONCLUSIONS
The recurrent nature, age predilection, and clinical presentation suggest that our patients display a unique clinical syndrome due to toxin-producing bacteria.
Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School at Camden, USA.
S M
SM
Manders
W R
WR
Heymann
E
E
Atillasoy
J
J
Kleeman
P M
PM
Schlievert
D000293:Adolescent; D000328:Adult; D000942:Antigens, Bacterial / Q000276:immunology; D001427:Bacterial Toxins / Q000276:immunology*; D004890:Erythema / Q000209:etiology* / Q000276:immunology / Q000382:microbiology; D006801:Humans; D008297:Male; D010502:Perineum; D012008:Recurrence; D013211:Staphylococcus aureus / Q000276:immunology / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000276:immunology / Q000302:isolation & purification; D018089:Superantigens / Q000276:immunology
D000942:Antigens, Bacterial; D001427:Bacterial Toxins; D018089:Superantigens