A 32-year-old woman presents to the emergency department after acutely developing a high fever, lightheadedness on standing, and a rash. At the hospital she develops vomiting, diarrhea, confusion, and abdominal pain. She goes on to develop evidence of multiorgan failure and is transferred to the intensive care unit. One week after the acute illness she develops desquamation of the skin. On further history, the illness started 3 days after the onset of menstruation. Which of the following is the most likely diagnosis?

TSS is most characteristically seen in females using vaginal tampons and is secondary to staphylococcal enterotoxins called TSS toxin 1 (TSST-1). Abrupt onset is characteristic. The clinical criteria for diagnosis include high fever, a diffuse rash that desquamates on the palms and soles over the subsequent 1-2 weeks, hypotension, and involvement in 3 or more organ systems. This involvement can include GI dysfunction (vomiting and diarrhea), renal insufficiency, hepatic insufficiency, thrombocytopenia, myalgias with elevated creatine kinase (CK) levels, and delirium Staphylococcal-scaled-skin syndrome most often affects new-born and children. It results in localized or quite extensive fluid-filled blisters that easily rupture to expose denuded skin. It is caused by an exfoliative toxin.