Clinical manifestation

Skin and mucous membrane changes: diffuse macular erythroderma or scarletini-

Traction alopecia 575

form eruption; erythema and edema of palms and soles; hyperemia of conjunctiva and mucous membranes, with strawberry tongue; delayed palm and sole desquamation

Other organ involvement: fever; hypotension; cardiomyopathy; nausea; vomiting; diarrhea; rhabdomyolysis; myalgias; muscle tenderness and weakness; azotemia; acute renal failure; adult respiratory distress syndrome; elevated serum glutamic oxaloacetic transaminase (SGOT) and serum bilirubin; thrombocytopenia; leuko-cytosis; disseminated intravascular coagulation; hypophosphatemia; hypocalcemia; electrolyte imbalance

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