Complete Heart Block In Toxic Shock Syndrome

Sir.—Toxic shock syndrome (TSS) is a clinical entity characterized by fever, hypotension, rash and mucous membrane involvement, and additional dysfunction of three major organ systems.^1,2 Circulatory manifestations of TSS usually reflect decreased vasomotor tone and massive fluid transfer from the intravascular to the interstitial space.^3-5 Although hemodynamically significant arrhythmias are rare, we describe here a patient with TSS who required ventricular pacing for life-threatening atrioventricular block. Of particular note is the application of non-invasive transthoracic pacing which provided effective circulatory support until a transvenous pacemaker could be inserted.

Patient Report.—A 14-year-old girl with Turner's syndrome was admitted to the Children's Hospital of Alabama, Birmingham, with cellulitis of the left foot and fever. She was well until 2 days earlier when she suffered a puncture wound to the left foot and was started on treatment with amoxicillin sodium. Her past medical history was significant for previously diagnosed