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