A 22-year-old woman presents to the emergency room with an 8-hour history of high fever, vomiting, diarrhea, and night sweats. Her temperature on admission is 38.7degC (103degF), blood pressure 100/60 mm Hg, and respirations 24 per minute. She has a diffuse desquamative erythematous rash. Upon pelvic examination, the patient is found to be menstruating, and a tampon is in place. A purulent exudate is found within the vagina, which is cultured and grows Staphylococcus aureus. The hemoglobin is 12 g/dL, and the platelet count is 40,000/mL. Which of the following represents the most common life-threatening complication of this patient's systemic disorder?

Toxic shock syndrome is an acute, sometimes fatal disorder characterized by fever, shock, and a desquamative erythematous rash. In addition, vomiting, diarrhea, myalgias, neurologic signs, and thrombocytopenia are common. Certain strains of Staphylococcus aureus release an exotoxin called toxic shock syndrome toxin-1. In addition to the pathologic alterations characteristic of shock, the lesions of disseminated intra-vascular coagulation (DIC) are usually prominent. The disease was first recognized when long-acting tampons were first introduced, providing sufficient time for the staphylococcal organisms to proliferate. The other choices are less common and may be secondary to DIC.Diagnosis: Toxic shock syndrome