Toxic Shock Syndrome Triggered by Thoracic Drain Insertion: A Pediatric Case Report
Kanako Omata1, Mami Ishida1, Takahiro Shindo1
1Department of Pediatrics, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Fukushima, Japan.
Insights
Toxic shock syndrome (TSS) can occur after routine procedures like thoracentesis. Early recognition of symptoms such as fever and rash is crucial for prompt diagnosis and treatment, even with seemingly clean wounds.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Surgical site infections
Background:
- Postoperative toxic shock syndrome (TSS) carries high morbidity and mortality.
- Surgical awareness is vital for timely TSS recognition and management.
- This case highlights TSS following a pediatric thoracentesis procedure.
Observation:
- A 14-year-old boy developed fever, vomiting, and hypotension post-thoracentesis for pneumothorax.
- Initial diagnosis was gastroenteritis, but septic shock prompted ICU transfer.
- Staphylococcus aureus and TSS toxin production were confirmed from pleural fluid and drain tip cultures.
Findings:
- The patient was diagnosed with TSS triggered by thoracic drain insertion.
- Prompt treatment with antibiotics, immunoglobulin, and supportive care led to rapid improvement.
- Skin desquamation and eczema were noted post-discharge, consistent with TSS.
Implications:
- Thoracentesis, a common procedure, can precipitate TSS.
- Clinical suspicion for TSS should be raised with symptoms like fever, rash, vomiting, and diarrhea, irrespective of wound appearance.
- Cultures of relevant fluids and drain tips are essential for confirming the diagnosis.
Introduction:
Postoperative Staphylococcus and streptococcal toxic shock syndrome (TSS) are associated with significant morbidity and mortality rates. As a result, surgical awareness is required to recognize and treat TSS appropriately. We report a pediatric case of TSS after thoracentesis for a pneumothorax.
Case Presentation:
A 14-year-old boy was diagnosed with a right pneumothorax and underwent thoracentesis with a trocar catheter. After 2 days, the patient developed a fever, headache, vomiting, and diarrhea. No obvious contamination of the drain puncture wound was observed. He was diagnosed with acute gastroenteritis and received intravenous treatment. On the 4th day after drainage, his blood pressure decreased. Due to suspected septic shock, he was transferred to the intensive care unit and administered antibiotics, immunoglobulin, and a hypertensive agent. His treatment response was good, and his general condition improved relatively quickly. On the 6th day, the patient was discharged from the intensive care unit. Although the air leak from the thoracic drain disappeared on day 3, the drain remained in place until day 8. Blood cultures obtained at the time of septic shock were all negative; however, pleural fluid and thoracic drain tip cultures detected Staphylococcus aureus, and the production of TSS toxin-1 and enterotoxin type C was confirmed. Retrospectively, the patient was diagnosed with TSS triggered by the insertion of a thoracic drain. He was discharged from the hospital on day 11. After discharge, he experienced skin desquamation of the axilla and buttocks. The patient also reported diffuse erythematous eczema on day 3 after drainage. He received antimicrobial therapy for 14 days and recovered fully without any complications.
Conclusions:
TSS can occur after simple, routine procedures such as thoracentesis. Symptoms such as fever, rash, vomiting, and diarrhea should raise concern for TSS and prompt further exploration and cultures, even in benign-appearing postoperative wounds.
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