Postoperative toxic shock syndrome following total gastrectomy—a case report—

Abstract

Toxic shock syndrome (TSS) is a severe vigorous multisystemic disorder resulting from a Staphylococcal exotoxin. To date, seven cases of TSS following gastrectomy have been reported in Japan. This report describes a rare case of toxic shock syndrome after gastrectomy.
A 68-year-old man, with IIc type gastric carcinoma at the upper body of the stomach by a medical check-up, was admitted to our hospital and underwent distal gastrectomy with level 2 lymph nodes dissection. Despite prophylactic administration of CEZ for postoperative 3 days, remarkable increases in the white blood cell count and CRP and high fever were noted on the first postoperative day, followed by hypotension on the 3rd p.o.d.when the patient went into shock. CRP was changed to PAPM/BP, but he developed DIC and ARDS on the 4th p.o.d.. Erythroderma around the surgical wound was noted on the 5th p.o.d.. Methicillin resistant staphyrococcus aureus was cultured from the surgical wound and was identified the presumed etiologic agent in the patient's life-threatening illness, toxic shock syndrome toxin-1 (TSST-1) producing from the nasal cavity. Culture of the infected wound yielded MRSA that had produced TSST-1. The patient recovered fully with supportive care, antibiotics, and surgical debridement of the surgical wound. Early recognition and prompt aggressive symptomatic treatments based essentially on fluids administration, appropriate intravenous antibiotics may avert the significant morbidity with TSS.