Abstract
We report a case of toxic shock syndrome (TSS) by methicillin-resistant Staphylococcus aureus (MRSA), developing a rapid necrosis of upper and lower extremities. A 34-year-old man injured left tibia during his work and osteosynthetic surgery of the tibia was performed. On postoperative day (POD) 1, he had a high fever, nausea, vomiting, diarrhea and skin rash. On POD 3, he was admitted to our ICU due to severe hypotension and acute renal failure. At first, we diagnosed his disease as a septic shock even though the origin of infection was unknown. We administered vasopressors and antibiotics, and induced continuous hemodiafiltration. However, the tip of his extremities became necrotic. On POD 5, toxin-producing MRSA was cultured from left knee fluid, and his disease was diagnosed as TSS. After administration of anti-MRSA drug as well as lavage and drainage of the surgical site, TSS seemed to be controlled. However, because the necrotic extremities could be additional focuses of infection, amputations of bilateral legs and fingers were performed. As early diagnosis and adequate treatments are essential for patients suffering from TSS, TSS should be one of the differential diagnoses in patients with septic shock accompanied by skin rash, and we should recognize that most strains of MRSA produce TSS-related toxins.
