Two Cases of Toxic Shock Syndrome after Endoscopic Sinus Surgery

Abstract

Toxic shock syndrome (TSS) is caused by toxic shock syndrome toxin-1 (TSST-1) produced by Staphylococcus aureus. Once it occurs, serious complications, such as shock, DIC, and multiple organ failure, could result. Early diagnosis and treatment are essential, but sometimes difficult. We report two cases of TSS after endoscopic sinus surgery (ESS). A 54-year-old female was referred to our hospital with eosinophilic sinusitis accompanied by recurrent nasal polyps. After undergoing ESS, she lapsed into a pre-shock state with cyanosis and blood pressure loss the next morning. Diarrhea and diffuse eruptions appeared after onset. Early treatment consisting of anti-bacterial administration and nasal irrigation was performed immediately. Clinical symptoms improved in a few days after onset. The other case involved a 15-year-old male who underwent ESS (modified endoscopic medial maxillectomy) for antrochoanal poly in the maxillary sinus. High-grade fever and diarrhea appeared 13 days after surgery. Delayed onset of TSS was strongly suggested, so he was admitted for internal care. Fortunately, the clinical symptoms improved 2 days after receiving similar treatment as in the first case. It is known that onset of TSS could be early or delayed. Early onset of TSS occurs within a few days after surgery. However, delayed onset of TSS occurs about 2 weeks after surgery. Therefore, we have to be mindful of severe delayed complications.