Non-menstrual associated toxic shock syndrome.

A 40-year-old female patient developed toxic shock syndrome following breast surgery. A toxin producing strain of Staphylococcus aureus was isolated from the post-operative wound. INTRODUCTION The term toxic shock syndrome (TSS) was first used in 1978 1 to describe a condition characterised by sudden onset of fever, shock, confusion, subcutaneous oedema, erythematous rash which desquamates in convalescence, abnormalities of many other systems, and negative blood culture. These effects are thought to be due to circulating staphylococcal toxins arising from a focus of staphylococcal infection. It has most commonly been associated with the use of certain types of tampons during menstruation, but is now increasingly being recognised in up to 13 % of cases in a variety of clinical situations not associated with menstruation.2 Staphylococcus aureus has been associated with TSS and most strains isolated from patients with this syndrome have produced enterotoxin F or pyrogenic exotoxin C, now thought to be the same toxin and renamed Toxic Shock Syndrome Toxin-1 (TSST-1). However, other strains of Staphylococcus aureus implicated in the syndrome have produced different toxins, particularly entero-toxins B and C 3 in non-menstrual cases. Mortality is higher in these cases with non-TSST-1 producing strains than with TSST-1 producing strains.4 We report here a patient who fulfilled the