Toxic shock syndrome following laparoscopic cholecystectomy

Toxic shock syndrome has been described in three clinical situations: pediatric abscesses; menses, especially among women using highly absorbent tampons; and after surgery. The syndrome is marked by the sudden onset of fever, a sunburn-like rash, and hypotension, and is associated with recovery of toxin-producing Staphylococcus aureus, usually from small amounts of serous or seropurulent fluid. The syndrome usually begins 1 to 2 days after the procedure. To date, no cases have been reported after laparoscopic surgery. We describe a case of postoperative toxic shock syndrome in a 41-year-old woman who underwent laparoscopic cholecystectomy. She required a second operation, antimicrobial therapy, and blood pressure support and eventually recovered fully. Culture of the operative bed yielded S. aureus that produced enteroxin B. Surgeons should investigate vigorously any fever and hypotension developing in the first 24 to 48 hours after laparoscopy. Toxic shock syndrome should be considered in the differential diagnosis.