Early Diagnosis of Menstrual Toxic Shock Syndrome via the Medical History: A Case Report

Abstract

A 44-year-old Japanese woman had a fever 3 days before visiting our hospital. Two days later, she visited a nearby clinic and received antibiotics for a suspected urinary tract infection. On the following day, because her symptoms worsened with a fever of 40ºC, systemic muscle pain, diarrhea, and vital signs indicating shock, she visited the clinic again and was referred to our hospital. She presented with conjunctival congestion, disuse erythema on her face, limbs, and trunk, and elevated inflammatory markers (white blood cells 17,700 /μL; C-reactive protein 34 mg/dL). Systemic contrast-enhanced computed tomography provided no useful information about the source of the fever. Because she was menstruating and had a history of tampon use, we suspected Toxic Shock Syndrome (TSS), hospitalized her, and began administration of replacement fluid, hypertensive agents, and combination antibiotic therapy. The blood culture was negative, but the vaginal culture showed methicillin-sensitive Staphylococcus aureus . On the 7th hospital day, the diagnosis of TSS was confirmed with the appearance of desquamation on her palms and soles in addition to other findings. Among the disease that result in septic shock, although TSS is likely to lead to death due to multiple organ failure, diagnosis may be difficult if an appropriate medical history is not obtained to clarify the diagnosis of TSS. In recent years, the rate of tampon use has increased in Japan. Menstrual TSS, as a differential diagnosis of febrile diseases with shock, is expected to become important.