A case of toxic shock syndrome (TSS) induced by methicillin-resistant staphylococcus aureus (MRSA) presenting as acute renal failure with disseminated intravascular coagulation

• Published in: Nihon Jinzo Gakkai shi Vol. 38; no. 1; pp. 27 - 32
• Main Authors: FUKUUCHI, Fumiko, HIDA, Miho, FUJIMOTO, Yasushi, HIRAGA, Seigo, SATOH, Takeshi
• Format: Journal Article
• Language: Japanese
• Published: Japan Japanese Society of Nephrology 1996
• Subjects: Acute Kidney Injury - etiology; acute renal failure (ARF), methicillin-resistant staphylococcus aureus (MRSA), toxic shock syndrome (TSS), disseminated intravascular coagulation (DIC); Aged; Anti-Infective Agents - therapeutic use; Antibiotics, Antitubercular - therapeutic use; Bacterial Toxins; Ciprofloxacin - therapeutic use; Disseminated Intravascular Coagulation - etiology; Enterotoxins - analysis; Female; Humans; Methicillin Resistance; Rifampin - therapeutic use; Shock, Septic - complications; Shock, Septic - diagnosis; Shock, Septic - drug therapy; Staphylococcal Infections - complications; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Staphylococcus aureus - drug effects; Superantigens
• ISSN: 0385-2385; 1884-0728
• DOI: 10.14842/jpnjnephrol1959.38.27

A case of a 73-year-old woman with acute renal failure due to toxic shock syndrome (TSS) is reported. The patient was admitted to our hospital with the complaints of high fever, disturbance of consciousness and shock. Laboratory findings on admission were; CRP 25.11 mg/dl, WBC 35000/ μl, Plt 1.6 × 10 4 / μ1, GOT 155 U/l, GPT 65 U/l, CPK 4202 U/l (CPK-MM 96%), BUN 123 mg/dl and SCr 7.0 mg/dl. Because of anuria, hemodialysis was perfomed. This patient was treated with dopamine, methyl prednisolone (MP), frozen fresh plasma, AT III, antibiotics, and platelet transfusion. The bacterial cultures of blood and cerebrospinal fluid were negative, but MRSA was isolated subsequently from the pharynx and vagina. We investigated the production of toxic shock syndrome toxin 1 (TSST-1) and staphylococcal enterotoxins (SE). The isolated MRSA produced TSST-1, SEB and SEC. Accordingly, we made the diagnosis of TSS. After improvement of acute renal failure and the patient's general condition, MRSA persisted and TSST-1 was still found in the patient's blood. Finally we eradicated the MRSA and TSST-1 after administration of ciprofloxacin hydrochloride (CPFX) and Rifampicin (RFP).