Biochemical investigation is no substitute for clinical examination!

CONTEXT Toxic shock syndrome has been shown previously to be associated with hyperamylasaemia. However, serum amylase levels do not usually exceed three times upper limit of normal in these cases. CASE REPORT We report a case of a young girl of 17 years who presented with upper abdominal pain, severe shock and raised serum amylase level of 3,898 U/L, giving an impression of severe acute pancreatitis. It was only after finding a tampon in her vagina, and subsequently growing Staphylococcus aureus in her blood cultures, did the diagnosis of toxic shock syndrome become apparent. She recovered fully with supportive treatment and appropriate antibiotics. CONCLUSIONS Toxic shock syndrome with such a high level of serum amylase has not been previously reported. This case exemplifies the importance of repeated clinical evaluation of patients in this era of multiple investigations, and not simply relying on biochemical values for diagnosis.