Rapid-Onset Menstrual-Associated Toxic Shock Syndrome in an Adolescent Female: A Case Report and Clinical Review

Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated illness caused by Staphylococcus aureus or Streptococcus pyogenes. Since its initial recognition in the late 1970s, menstrual-associated TSS has been closely linked to tampon use. While regulatory changes to tampon composition have reduced incidence, TSS continues to be an important cause of fulminant sepsis in adolescents.

We describe a 16-year-old female who presented with five days of suprapubic pain, nausea, diarrhea, and fever who later developed sore throat, vomiting, rash, and mucous membrane involvement. Examination revealed tachycardia, strawberry tongue, erythematous lips, and a diffuse macular rash. Laboratory studies demonstrated leukocytosis with left shift, hyponatremia, elevated bilirubin, and elevated CRP, consistent with early multiorgan dysfunction. Blood and urine cultures were negative. She was managed with intravenous fluids and empiric broad-spectrum antibiotics including clindamycin with subsequent resolution of hemodynamic instability and complete recovery by hospital day four.

TSS is primarily a clinical diagnosis. It requires careful clinical differentiation, as its presentation with fever, hypotension, rash, mucous membrane involvement and multiorgan dysfunction may overlap with PID with progression to sepsis. Management centers on rapid hemodynamic stabilization, empiric antibiotic therapy with agents that suppress toxin production, and removal of the inciting source.

Our case highlights the continued relevance of menstrual-associated TSS in adolescents, and the diagnostic challenges posed by its clinical overlap with other pediatric inflammatory syndromes. We emphasize the importance of early recognition, aggressive supportive care, and appropriate antimicrobial therapy in achieving favorable outcomes.