Menstrual toxic shock syndrome: A systematic review of imaging findings

Menstrual toxic shock syndrome (mTSS) is a rare, life-threatening condition mainly affecting young menstruating women. While the clinical and microbiological aspects of mTSS are well-documented, consolidated evidence on its radiologic findings remains limited in the literature. This study aimed to systematically review published case reports of mTSS to describe the spectrum of radiologic findings and assess the role of imaging in diagnosis and management. A systematic search of Medline and Embase was conducted from the earliest available records to September 2024. Case reports were included if they described mTSS cases meeting CDC criteria and involved imaging in diagnosis or management. Twelve eligible reports were identified and analyzed for demographics, microbiology, imaging modality and findings, clinical course, and patient outcome. Imaging was typically performed early during hospitalization and included CT, ultrasound, chest x-ray, and echocardiography. Pulmonary findings were most common, including bilateral infiltrates and features of acute respiratory distress syndrome (ARDS) or septic emboli. Abdominal and pelvic imaging revealed ascites, mesenteric edema, bowel wall thickening, and adnexal inflammation. Imaging also identified sources of infection, such as intrauterine devices, and guided management decisions such as drainage or ICU admission. In some cases, imaging was normal despite severe clinical presentations. While radiologic findings are non-specific, their presence supports the clinical suspicion of mTSS and helps assess systemic complications. This review highlights the importance of early, multimodal imaging in patients with unexplained shock or fever, particularly in menstruating women, and emphasizes the need for interdisciplinary collaboration in managing this syndrome.