title: Toxic shock syndrome of a probable gynecologic source in an adolescent: a case report and review of the literature.
abstract: BACKGROUND
  Toxic shock syndrome (TSS) is an acute toxin-mediated infectious syndrome characterized by fever, hypotension, desquamation, and multiorgan involvement. It is a rare condition (incidence of 0.79/100,000 women), particularly in the adolescent population, and it may be menstrual (mTSS) or non-menstrual (nmTSS) in origin.
  
  
  METHODS
  A 15-year-old girl developed symptoms of nausea, vomiting, and diarrhea that worsened over a 3-day period. At initial presentation, she was hypotensive, febrile, and tachycardic. Her condition deteriorated and within 36 hours she required intubation, vasopressor treatment, and antibiotic therapy. Multiple sites were cultured but only the vaginal culture, which grew Staphylococcus aureus, was positive. Recent menses with tampon use was reported. She responded to aggressive therapy and was discharged home 3 weeks after initial presentation.
  
  
  CONCLUSIONS
  We describe a rare case of TSS of a probable gynecologic source in a 15-year-old female who successfully responded to aggressive intensive care treatment. mTSS should be considered in the differential diagnosis of an adolescent presenting with signs of septic shock, particularly if there is a recent history of tampon use. Early intervention is critical to improving survival.
authors.affiliation: Department of Obstetrics, Gynaecology, and Newborn Care, The University of Ottawa, Ottawa, Canada.
authors.forename: Tammy
authors.initials: T
authors.lastname: LeRiche
authors.forename: Amanda Y
authors.initials: AY
authors.lastname: Black
authors.forename: Nathalie A
authors.initials: NA
authors.lastname: Fleming
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D052576:Menstrual Hygiene Products; D008598:Menstruation; D012772:Shock, Septic / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy*; D014621:Vagina / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents