Toxic shock syndrome toxin-I producing Staphylococcus aureus in fulminant necrotizing fasciitis

We describe a patient presenting with fulminant monomicrobial necrotizing fasciitis (NF) and toxic shock syndrome (TSS) caused by Staphylococcus aureus producing toxic shock syndrome toxin-I (TSST-I). To our knowledge, TSST-I positivity combined with NF has been described only once in previous literature. We discuss the clinical and pathophysiological aspects of both necrotizing fasciitis and toxic shock syndrome and provide a comprehensive overview of causative micro-organisms and the different toxins they produce. We conclude that intravenous immunoglobulin (IVIG) treatment might be considered not only in streptococcal but also in staphylococcal NF.