Abstract
A 13-year-old adolescent presented with symptoms compatible with septic shock following a vacation by the lake. Initially, she presented with gastrointestinal symptoms and fever, and later she developed rash, arthralgia, myalgia, asthenia, erythroderma and conjunctival hyperemia; moreover, her blood tests showed elevated inflammatory markers and acute renal failure. Despite antibiotic therapy and fluid resuscitation, the patient showed refractory hypotension requiring vasopressor support. The hypothesis of Toxic Shock Syndrome (TSS) arose from the history of a prolonged use of menstrual vaginal tampons. Treatment with penicillin and clindamycin led to rapid clinical improvement. TSS, caused by toxins produced by Staphylococcus aureus, presents with nonspecific symptoms, but prompt clinical suspicion is crucial for timely treatment. The first described etiology is the prolonged use of menstrual vaginal tampons, although non-menstrual-related causes of TSS are equally common. Antibiotic therapy, hemodynamic support and occasionally surgical debridement are fundamental for its prompt management.
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