Abstract
Toxic shock syndrome is a serious complication of Streptococcus pyogenes or Staphylococcus aureus infections associated with very high morbidity and mortality. Postoperative toxic shock syndrome is an extremely rare phenomenon which manifests as fevers, diffuse rash, septic shock, and death. We present the first reported case of toxic shock syndrome associated with a surgical site infection from a decompressive neurectomy for refractory migraines in a 41-year-old female as well as the first use of angiotensin-2 vasopressor therapy to treat persistent septic shock from toxic shock syndrome refractory to conventional therapies.
Highlights
Toxic shock syndrome (TSS) is a potentially lethal sequala of group A Strep (Streptococcus pyogenes) or Staphylococcus aureus infections which manifests with high fevers, diffuse erythematous rash, hypotension, and multisystem organ failure
We present the first reported case of TSS with septic shock, multisystem organ failure, and acute respiratory distress syndrome arising from a surgical site infection after decompressive occipital neurectomy for intractable migraine as well as the first report of successful use of angiotensin-2 vasopressor therapy to treat refractory septic shock from TSS
Our patient is currently being evaluated and fitted for prostheses, but will be significantly limited in her mobility and daily activities. She has made a remarkable recovery after presenting to the hospital in moribund condition. This is the first case report of postoperative streptococcal toxic shock syndrome arising from a surgical site infection after an occipital neurectomy for refractory migraines
Summary
Toxic shock syndrome (TSS) is a potentially lethal sequala of group A Strep (Streptococcus pyogenes) or Staphylococcus aureus infections which manifests with high fevers, diffuse erythematous rash, hypotension, and multisystem organ failure. Postoperative TSS is a rare clinical entity occurring in only 0.003% of surgical cases [1]. Treatment of TSS in these cases requires a high index of suspicion, early antibiotic administration, and aggressive hemodynamic support. We present the first reported case of TSS with septic shock, multisystem organ failure, and acute respiratory distress syndrome arising from a surgical site infection after decompressive occipital neurectomy for intractable migraine as well as the first report of successful use of angiotensin-2 vasopressor therapy to treat refractory septic shock from TSS
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