Tampon-related toxic-shock syndrome. Histopathologic and clinical findings in a fatal case

Toxic-shock syndrome (TSS) is consistently associated with penicillin-resistant Staphylococcus aureus in the vagina of menstruating women who use tampons. Increasing evidence implicates Staphylococcal toxin(s) in the pathogenesis of the condition, but the nature and biological effects of such toxin(s) are not established. Comprehensive postmortem studies and histopathologic data are few and largely unknown. The autopsy of a 15-year-old girl with this syndrome showed extensive superficial ulcerations and thrombophlebitis of the vagina, with bacteria on the mucosal surface only. Systemic phlebitis and capillaritis, visceral interstitial edema and acute inflammation involving various organs suggest a toxic effect, which is primarily manifested by widespread vascular damage. The histogenesis of the vaginal ulcerations remains unclarified, although they probably contribute to the absorption of toxin(s).