Toxic shock syndrome associated with vulvar necrotizing fasciitis.
BACKGROUND
Fifty percent of toxic shock syndrome is associated with nonmenstrual etiologies such as postoperative wound infection.


METHODS
A 44-year-old woman developed necrotizing vulvar fasciitis that was successfully treated with surgical debridement and broad-spectrum antibiotics. However, after improving for 3 days postoperatively, she developed fever, a generalized maculopapular rash, and renal and liver abnormalities. As her condition worsened, she developed hypotension and respiratory distress. After 5 days in the intensive care unit, she gradually improved. Her wound culture from admission grew multiple organisms, including Staphylococcus aureus that produced toxic shock syndrome toxin-1.


CONCLUSIONS
Toxic shock may occur in varied gynecologic settings, including pelvic and perineal infection. Successful management requires a prompt and aggressive response to multi-organ system failure.
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill.
D E
DE
Farley
V L
VL
Katz
D J
DJ
Dotters
D000328:Adult; D005208:Fasciitis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D009336:Necrosis / Q000601:surgery; D011183:Postoperative Complications / Q000382:microbiology*; D012772:Shock, Septic / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D014845:Vulvar Diseases / Q000473:pathology / Q000601:surgery*