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. 2021 Dec:89:106587.
doi: 10.1016/j.ijscr.2021.106587. Epub 2021 Nov 10.

Post-surgical staphylococcal toxic shock syndrome in pediatrics: A case report

Yousef S Abuzneid  1 , Abdelrahman Rabee  2 , Hussam I A Alzeerelhouseini  2 , Deema W S Ghattass  2 , Nermeen Shiebat  2 , Radwan Abukarsh  3
Affiliations

Post-surgical staphylococcal toxic shock syndrome in pediatrics: A case report

Yousef S Abuzneid et al. Int J Surg Case Rep. 2021 Dec.

Abstract

Introduction: Toxic shock syndrome (TSS) is a rare but serious, life-threatening medical condition and potentially lethal if not detected and treated early. It is mainly caused by a toxin called toxin-1 produced by Staphylococcus aureus, and characterized by fever, hypotension, rash, skin desquamation and multisystem involvement.

Case presentation: Herein, we describe a nine-month-old male patient who presented to the hospital complaining of fever, vomiting and hypoactivity on day one post-orchidopexy. During hospitalization, his condition began to deteriorate with signs and symptoms of multisystemic failure. Laboratory tests and radiological images were done, leading to the decision to reopen and drain the surgical wound. Wound and nasal swabs were cultured and showed S. aureus infection, and the diagnosis of toxic shock syndrome was confirmed.

Discussion: TSS is a systemic illness resulting from overwhelming host response to bacterial exotoxins, that cause T cells activation and the release of pro-inflammatory cytokines (IL-1 and TNF-α causing fever, hypotension, and tissue injury). Also, it can present with CNS signs that may be misdiagnosed with meningitis in pediatrics. It requires early identification and treatment despite its rarity with mortality rate of 81% even with treatment. The patient's presentation, examination and laboratories tests with the blood and wound cultures were highly suggestive for this condition.

Conclusion: Physicians must maintain a high index of suspicion for TSS, as early diagnosis and treatment make a difference. This condition shouldn't be excluded even in young age patients or after simple procedure as in our case in which TSS occurred after orchidopexy.

Keywords: Infection; Pediatric surgery; Post-surgical; Toxic shock syndrome.

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Conflict of interest statement

There is no conflict of interest.

Figures

Fig. 1
Fig. 1
Skin desquamation seen in post-operative day 10.
Fig. 2
Fig. 2
A. Opened wound for drainage after debridement of infected necrotic tissue. B. Closed wound after the removal of the drainage showing the skin in good conditions with no discharge before going home.
See this image and copyright information in PMC

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