2021 Volume 95 Issue 5 Pages 372-376
A 39-year-old woman was admitted to our hospital with pyelonephritis. While she was hospitalized, she developed septic shock with watery diarrhea, diffuse erythema, and multi-organ failure. She reported having used a vaginal tampon for two days before she was admitted. Staphylococcal toxic shock syndrome toxin-1- producing, methicillin-susceptible Staphylococcus aureus (S. aureus) was identified in a vaginal fluid specimen,and we made the diagnosis menstruation-associated S. aureus toxic shock syndrome (TSS). Transthoracic echocardiography showed diffusely reduced left ventricular wall motion, and a left ventricular ejection fraction of 20%. As the shock state and multi-organ failure persisted despite removal of the tampon, antimicrobial therapy, fluid resuscitation, and vasopressor use, immunoglobulin therapy was attempted. After the administration of immunoglobulin, the shock and multi-organ failure improved, and the patient was discharged after 15 days of hospitalization. Fourteen days after discharge, transthoracic echocardiography no longer showed left ventricular wall motion abnormalities, and the left ventricular ejection fraction had improved to 60%. While S. aureus TSS is rarely associated with cardiomyopathy, the possibility of cardiomyopathy should be considered in cases of refractory shock. In patients diagnosed as having S. aureus TSS, immunoglobulin administration should be considered in cases where the circulatory failure and multi-organ failure persist even after appropriate drainage and antimicrobial therapy.
