Advanced cervical carcinoma presenting with toxic shock syndrome

Toxic shock syndrome is a multisystem disease which presents with a high fever, rash, gastrointestinal symptoms, and hypotension. A 58-year-old woman presented to the emergency room with these symptoms, hypotension and tachycardia. Because of vaginal spotting a pelvic examination was performed which demonstrated vulvo/vaginal erythema and a large vaginal mass consistent with an advanced cervical cancer with bilateral pelvic sidewall fixation. Cervical/vaginal biopsy demonstrated invasive squamous cell carcinoma and an initial chest X ray demonstrated multiple pulmonary metastases. After a total of 8 days of antibiotic therapy the patient received cis-platinum chemotherapy. The toxic shock syndrome was the presenting symptomatology in this patient with advanced cervical cancer. Toxic shock syndrome has been associated with the use of hyperabsorbent tampons as well as numerous other gynecologic procedures but has not been reported in patients with gynecologic cancer.