Hypomagnesemia, hypocalcemia, and toxic-shock syndrome. A case report

Hypocalcemia is common in toxic-shock syndrome (TSS); however, the role of magnesium deficiency in TSS remains to be defined. A previously healthy nurse on no maintenance medication developed hypocalcemia and hypomagnesemia in association with characteristic TSS, presenting with fever, headache, mental confusion, erythroderma, watery diarrhea and abnormal liver functions tests. Coagulase-positive Staphylococcus aureus as well as staphylococcal toxin were isolated from the cervix. Calcitonin levels were normal. Serum magnesium and calcium levels were low at presentation and later intravenous magnesium loading demonstrated a marked rise in 1,25-(OH)2 vitamin D and parathormone (PTH), with high retention of the infused load consistent with functional hypoparathyroidism. Intracellular magnesium deficiency may be a significant factor in the pathogenesis of hypocalcemia in TSS and warrants routine clinical consideration.