Staphylococcal Toxic Shock Syndrome: The Critical Role of Early Recognition and Prompt Intervention

We describe a 16-year-old girl presenting with four days of nausea, vomiting, malaise, and macular rash affecting the vulva and perineum during menstruation, following tampon use. She was febrile, hypotensive, tachycardic, and confused, with multi-organ dysfunction.

Laboratory findings revealed leukocytosis, thrombocytopenia, renal impairment, markedly elevated CRP, and procalcitonin. Perineal swabs grew methicillin-sensitive Staphylococcus aureus resistant to clindamycin. Blood cultures were negative. The isolate was later confirmed to carry the tst gene encoding toxic shock syndrome toxin-1 (TSST-1).

Broad-spectrum antibiotics were started, later rationalised to IV flucloxacillin after isolation of methicillin-susceptible S. aureus. The patient required critical care admission for monitoring and vasopressors but recovered quickly and was discharged well. Skin desquamation across neck, vulva, and perineum was noted during recovery.

This case illustrates menstrual toxic shock syndrome due to TSST-1-producing S. aureus, occurring without evidence of prolonged tampon retention. Early recognition and management with microbiological testing are essential. Public education on safe tampon use remains vital to prevent this rare but life-threatening condition.