Case of the Month #33 Toxic Shock Syndrome

Published 12/08/2022

What is the management?

Mainstay of management includes: 

  • Early administration of appropriate antibiotics  

  • Source control which may include surgical debridement 

  • Supportive management in intensive/high dependency care 

Specific points: 

  • Clindamycin +/- Linezolid (toxin suppression) + Broad spectrum (eg. Meropenem/Tazocin) 

  • IVIG in confirmed Streptococcal TSS 

  • May require massive fluid resuscitation 

General ICU measures: 

  • Monitor for ARDS and invasive ventilation as necessary 

  • High dose vasopressor requirements 

  • DVT and stress ulcer prophylaxis 

  • Enteral nutrition and blood glucose control 

The patient undergoes CT imaging of her ankle with inconclusive results. She is transferred to theatres for emergency exploration of her left calf, and undergoes a debridement and washout with minimal invasion. She spends a total of 3 weeks on intensive care requiring level 3 multi-organ support before being transferred to the medical ward to complete her recovery.