A 24-year-old female presented to the ER with a characteristic rash and fever. On examination, chronic lower extremity ulcer - related to prior trauma, Hypotension and tachycardia were noted. Diffuse erythema - prominent on palms, conjunctiva and oral mucosa. Lab findings revealed deranged RFTs, moderately increased SGOT and SGPT, mild thrombocytopenia. The patient was resuscitated with IV fluid and vasopressors. Blood cultures were negative after 72 hours and now the fingers of the female sta to desquamate. Which of the organisms is the most likely cause of the above condition: -

This is a case of Toxic Shock Syndrome. The image shows the characteristic rash of toxic shock syndrome. The rash: - Involves skin and mucous membranes Macular, resembles a sunburn Involves the palms and soles More severe cases develop vesicles and bullae Non-pitting edema due to increases in interstitial fluid Late onset (1-3 weeks) develops into a pruritic maculopapular rash with desquamation of the palms and soles Toxic shock syndrome (TSS) is a toxin-mediated acute life-threatening illness, usually precipitated by infection with either Staphylococcus aureus (most common cause) or group A Streptococcus (GAS)/ Streptococcus pyogenes. It is characterized by high fever, rash, hypotension, multiorgan failure (involving at least 3 or more organ systems), and desquamation, typically of the palms and soles, 1-2 weeks after the onset of acute illness. The clinical syndrome can also include severe myalgia, vomiting, diarrhea, headache, and nonfocal neurologic abnormalities.