Abstract
We encounter a patient with toxic shock syndrome (TSS) without cutaneous symptom after operation for hilar cholangiocarcinoma. 69 year-old male was referred to our hospital with diagnosis of hilar cholangiocarcinoma and obstructive jaundice. After bilateral percutaneous transhepatic biliary drainage, extrahepatic resection combined with extended right hepatectomy was performed. Four days later, there was sudden drainage of massive purulent ascites, and his general condition deteriorated. MRSA was cultured from blood and ascites, and diagnosis of MRSA peritonitis was made. Despite intensive care, he complicated hepatic infarction and deceased 13days after surgery. Bacteriological examination revealed TSS toxin-1 (TSST-1) producing type MRSA. He met all criteria except for erythroderma and desquamation, and because of the presence of MRSA producing TSST-1, he was diagnosed as TSS. Since delay in the treatment of TSS can be critical in some cases after surgeries with overwhelming stress, early diagnosis and initiation of treatment including anti-MRSA agents and human immunoglobulin are essential.
