She appeared quite septic with diffuse rashes. I thought TSS. She also has no signs of meningitis which is characteristic of Meningiococcus.

Also the picture of the rash look like areas of blisters. smh

TSS: sunburn like rash particularly on the palms and soles and very rare

Meningococemia fits better for a college-age girl who has been living in cabins/dorms and cannot be aroused/altered mental status

https://rarediseases.org/rare-diseases/toxic-shock-syndrome/

• Young woman who has been in a confined space with others (summer camp, college, etc.) who presents with fever, altered mental status, hypotension and purpuric skin lesions, most consistent with meningococcemia
• Toxic shock syndrome –> Diffuse erythroderma
• Lyme disease –> Erythema chronica migrans (“bulls-eye rash”)

https://step-prep.org/tutoring/

I think the main differentiation is the extremities - cold in meningococcemia and warm in TSS

Meningococcal pharyngitis → meningococcal septicemia → Waterhouse-Friderichsen syndrome → shock/hypotension

TSS would have a fine measles-like "morbilliform" rash with peeling at palms. Also would have warm extremities not cool