Fatal streptococcal toxic shock syndrome from an intrauterine device

The occurrence of toxic shock syndrome from an intrauterine device (IUD) is very rare.

To raise awareness of the risk of toxic shock syndrome caused by an IUD, to educate others about when to suspect this complication, and to provide treatment recommendations.

A 49-year-old woman presented to the Emergency Department in septic shock after complaining of 5 days of nausea, vomiting, and diarrhea. Physical examination findings included a diffusely tender and rigid abdomen with free fluid on bedside sonogram. She was found, on computed tomography of her abdomen and pelvis, to have an IUD with moderate ascites. The IUD was removed, and both her IUD and her blood cultures grew out group A Streptococcus. Despite aggressive medical management, which included multiple vasopressors and broad-spectrum antibiotics, she died from group A streptococcal sepsis, with the IUD as her most likely source. Her clinical presentation and laboratory findings meet the Centers for Disease Control and Prevention diagnostic criteria for streptococcal toxic shock syndrome. Her diagnosis was confirmed by autopsy.

IUDs should be considered as a possible source of infection in patients with an IUD who present with symptoms consistent with toxic shock syndrome. These patients need to be aggressively managed with early surgical intervention.