Toxic Shock Syndrome Caused by Staphylococcal Infection After Breast Implant Surgery

Abstract

Toxic shock syndrome is a rare but life-threatening complication after breast implant surgery. We describe a 77-year-old woman who developed toxic shock syndrome caused by methicillin-resistant Staphylococcus aureus after breast implant reconstruction. Despite a high fever and markedly increased white blood cell count, suggesting severe infection, she initially had no symptoms of local findings, such as wound swelling and redness of the breast. Soon after diagnosis of toxic shock syndrome and removal of her breast implant, she was recovered from the shock state. To date, 16 cases of toxic shock syndrome have been reported, including this case, and they were related to breast implants or tissue expander surgery. The common and noteworthy characteristic of these cases was the lack of local findings, such as swelling or redness, which suggests infection. Therefore, early diagnosis is generally difficult, and the initiation of proper treatment can be delayed without knowledge of this characteristic. Toxic shock syndrome requires early diagnosis and treatment. If the patient has a deteriorated vital sign after breast implant surgery or tissue expander breast reconstruction, toxic shock syndrome should be suspected, even if there are no local signs of infection, and removal of the artifact should be considered as soon as possible.

Staphylococcal Toxic Shock Syndrome after Autologous Breast Reconstruction: A Case Report and Literature Review

“…6 A literature search of PubMed and Google Scholar using the search terms "breast reconstruction, TSS" indicated that 22 cases of TSS have been reported after breast reconstruction and augmentation procedures, including our case. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] (See figure, Supplemental Digital Content 1, which illustrates the TSS cases in breast reconstruction and augmentation surgery, http://links.lww.com/PRSGO/C305.) Eighteen cases were related to implants or tissue expander surgery, and four were associated with autologous breast reconstruction.…”

Toxic shock syndrome complicated with symmetrical peripheral gangrene after liposuction and fat transfer: a case report and literature review

“…In the last few decades, TSS has been mainly associated with menstruating women who use intravaginal tampons [ 19 , 30 ]. But with the rapid development of cosmetic surgeries, TSS has been observed a trend in increasing frequency in plastic surgical patients [ 31 , 32 ].…”

Antibacterial Designs for Implantable Medical Devices: Evolutions and Challenges

“…Antibiotic resistance in bacteria even multidrug-resistant (MDR) bacteria is now a worldwide challenge [ 91 ]. Antibiotic-resistant infections were frequently reported all over the world, including in both developing and developed countries ( Table 4 ) [ 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ]. During an infection, Staphylococcus aureus ( S. aureus ) often forms biofilms on implantable devices, which dramatically increases the ability of the species to acquire resistance via horizontal plasmid transfer [ 111 ].…”

“…This is why S. aureus has high rates of resistance. As shown by the typical cases reported in recent years ( Table 4 ), MRSA has become the most common strain causing infections of various implantable medical devices, including cardiac devices [ 93 , 95 , 99 , 103 , 106 ], orthopedic prosthetics [ 96 , 97 ], cochlear implants [ 98 ], breast implants [ 100 ], laryngeal implants [ 101 ], and stent grafts [ 109 ]. In addition, there is an alarming increase in antibiotic resistance in other strains, such as Acinetobacter baumannii [ 92 ], Mycobacterium chelonae [ 94 ], Enterobacter cloacae complex [ 102 ], S. epidermidis [ 104 , 110 ], Klebsiella pneumoniae [ 105 ], Staphylococcus haemolyticus [ 107 ], and Staphylococcal endophthalmitis [ 108 ], are also involved in various resistant DAIs.…”