Staphylococcal toxic shock syndrome associated with inappropriate wound-dressing of a leg abrasion

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Toxic shock syndrome (TSS) is an acute febrile illness characterized by hypotension, diffuse erythroderma, and multisystem involvement. In severe cases, TSS can cause multiple organ failure or death. TSS is associated with many clinical situations, such as menstruation, postoperative and postpartum recovery, burns, and respiratory infections. However, TSS associated with the use of wound-dressing for an abrasion has not previously been reported. Here we report a case of staphylococcal TSS associated with the inappropriate use of wound-dressing. A 21-year-old otherwise healthy man visited our hospital complaining of two days of fever, nausea, vomiting, and diarrhea. Four days prior to admission, he fell from his motorcycle and suffered a leg abrasion. The next day, a moist wound-dressing was applied. On admission, his body temperature was 39.7 °C and blood pressure 83/50 mmHg. He had diffuse erythroderma and conjunctival hyperemia. A workup revealed elevated serum creatinine and liver enzyme levels. We suspected TSS, so fluid resuscitation and treatment with antimicrobials were begun. Methicillin-sensitive Staphylococcus aureus, which produced TSST-1, was isolated from the wound exudate. A diagnosis of TSS was made. He was successfully treated through the use of antimicrobials and drainage of the infected wound. He was discharged 14 days after admission without any sequelae. This is the first report of a case of staphylococcal TSS associated with the inappropriate use of a wound-dressing for an abrasion. TSS caused by wound-dressing may be rare but should be made well-known to both health care providers and the public.