A CASE OF TOXIC SHOCK SYNDROME INDUCED BY METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) AFTER OPERATION FOR GASTRIC CANCER

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 65; no. 10; pp. 2647 - 2651
• Main Authors: NIKKUNI, Keiya, NAGAHASHI, Masayuki, MAKINO, Shigeto, NISHIMURA, Atsushi, KAWACHI, Yasuyuki, SHIMIZU, Takeaki
• Format: Journal Article
• Language: English
• Published: Japan Surgical Association 2004
• Subjects: MRSA; toxic shock syndrome (TSS); toxic shock syndrome toxin-1 (TSST-1)
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.65.2647

Toxic shock syndrome (TSS) is an acute, toxin-mediated febrile disease characterized by rapid onset of high fever, hypotension, skin eruption and variety of other signs and symptoms. It rapidly leads to multiple organ failure with serious morbidity and mortality. There are few reports on definite TSS after gastrectomy in Japan. We report a case of TSS occurred after operation for gastric cancer. A 48-year-old woman with early gastric cancer underwent a proximal gastrectomy on December 26, 2003. Two days after the operation, she had a spiking fever up to 40°C followed by hypotension and oliguria. Generalized erythematous macular rash, hepatic dysfunction and diarrhea also appeared. On the 5th postoperative day, she developed ARDS and DIC. Bacterial culture of the stool and pus from surgical wound yielded Methicillin resistant staphylococcus aureus producing toxic shock syndrome toxin-1. She fulfilled the criteria for the case definition of TSS within the CDC guidelines. Surgical drainage was performed and intraveous antibiotic therapy with VCM was initiated immediately. As a result of appropriate intensive care for multiple organ failure, she recovered from TSS.