Non-menstrual Toxic Shock Syndrome

Abstract

Non-menstrual Toxic Shock Syndrome. 1990; 10(2): 221-222 To the Editor: I read with interest the letter by Fahim 1 and would like to describe my own observations in a patient with non-menstrual toxic shock syndrome, with an emphasis on severe hepatic dysfunctions as a complication of the syndrome. My patient made a complete recovery because of early diagnosis and effective treatment.A 28-year-old Saudi woman presented with abrupt onset of fever, sore throat, vomiting, confusion, generalized erythrodermic blanching rash, and hypotension, two weeks following a full-term vaginal delivery. On the seventh day following admission, her skin rash began to desquamate and she became deeply jaundiced with moderate ascites.Laboratory investigations showed the following values: hemoglobin, 84 g/L; white cell count, 24.0 × 10 9 /L; platelets, 100 × 10 9 /L; blood urea, 20.4 mmol/L; creatinine, 210 μmol/L; sodium, 120 mmol/L; calcium, 1.63 mmol/L; and magnesium, 0.5 mmol/L. Liver function tests showed bilirubin, 529 μmol/L; AST 18.1 μkat/L; and ALT, 19.6 μkat, with normal alkaline phosphatase activity. Abdominal ultrasound examination showed a normal gallbladder and biliary tree with moderate ascites. Culture from the vagina showed a concentrated growth of Staphylococcus aureusShe was treated with intravenous vancomycin, dopamine, calcium chloride, and fluids (normal saline and crystalloids), and she made a complete recovery. At the time of the patient's discharge, all laboratory values were normal.This case fulfilled the criteria for toxic shock syndrome. Grossly abnormal liver function values with hyperbilirubinemia, markedly elevated transaminase enzyme activity, and normal alkaline phosphate levels, as seen in my patient, have been reported only for two fatal cases studied by Larkin et al. 2 Physicians should be aware of this complication of hepatic dysfunction in toxic shock syndrome, as early diagnosis, adequate fluid replacement, vasopressor therapy, and appropriate antistaphylococcal antibiotics can prevent fatal outcome.