[Toxic shock syndrome due to osteomyelitis]

Area of Science:

• Pediatric Critical Care Medicine
• Infectious Diseases
• Nephrology

Background:

• Toxic-Shock-Syndrome (TSS) is a rare but serious complication, often associated with Staphylococcus aureus or Streptococcus pyogenes infections.
• Osteomyelitis, a bone infection, can serve as a nidus for systemic infections, including TSS.
• Managing severe hypotension and potential fluid overload in TSS requires careful consideration of hemodynamic support and organ protection.

Observation:

• An 11-year-old female presented with TSS subsequent to osteomyelitis, exhibiting profound hypotension, petechiae, hematoma formation in lower extremities, and severe oropharyngeal bleeding.
• Aggressive fluid resuscitation with approximately 15 liters of colloidal solutions, primarily frozen plasma, was necessary to stabilize blood pressure.
• The patient developed signs suggestive of impending pulmonary compromise due to fluid shifts.

Findings:

• Continuous veno-venous hemofiltration (CVVH) was initiated to manage fluid balance and prevent pulmonary edema.
• CVVH effectively mitigated the risk of acute respiratory distress syndrome (ARDS) by controlling the redistribution of interstitial fluid.
• The patient's hemodynamic status improved with intensive management, including CVVH.

Implications:

• This case highlights the critical role of CVVH in managing severe TSS with significant fluid shifts and risk of ARDS in pediatric patients.
• Early recognition and aggressive management of TSS complications, including judicious use of renal replacement therapy, are crucial for favorable outcomes.
• Further research into the specific mechanisms of fluid dysregulation in TSS and the optimal timing for interventions like CVVH is warranted.