title: Toxic Shock Syndrome Caused by Methicillin-Resistant Staphylococcus aureus (MRSA) After Expander-Based Breast Reconstruction.
abstract: OBJECTIVE
  Toxic shock syndrome is a rare but life-threatening complication after plastic surgery procedures.
  
  
  METHODS
  We experienced 2 cases of toxic shock syndrome after expander-based breast reconstruction caused by methicillin-resistant Staphylococcus aureus.
  
  
  RESULTS
  The first patient took a severe clinical course due to the delayed diagnosis and treatment, and the second patient recovered rapidly after the early diagnosis and treatment based on our experience of the first case. Fever, rash, and gastrointestinal symptoms (diarrhea and/or vomiting) were characteristic and important for the early diagnosis of toxic shock syndrome.
  
  
  CONCLUSIONS
  Considering the increased prevalence of methicillin-resistant Staphylococcus aureus, we should suspect methicillin-resistant Staphylococcus aureus in cases of toxic shock syndrome that occur postoperatively, and the empiric administration of vancomycin should be initiated in such cases.
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Suga
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shiraishi
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takushima
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Harii
keywords: breast reconstruction; complication; expander; methicillin-resistant Staphylococcus aureus; toxic shock syndrome
references.citation: Plast Reconstr Surg. 1997 Mar;99(3):875-9
references.pmid: 9047212
references.citation: PLoS One. 2011;6(8):e22997
references.pmid: 21860665
references.citation: Lancet Infect Dis. 2009 May;9(5):281-90
references.pmid: 19393958
references.citation: Ann Plast Surg. 2005 May;54(5):553-6
references.pmid: 15838219
references.citation: Ann Plast Surg. 1986 Dec;17(6):532-3
references.pmid: 3827124
references.citation: Plast Reconstr Surg. 1995 Dec;96(7):1702-8
references.pmid: 7480294
references.citation: Aesthetic Plast Surg. 1998 May-Jun;22(3):180-4
references.pmid: 9618183
references.citation: Lancet. 1978 Nov 25;2(8100):1116-8
references.pmid: 82681
references.citation: Ann Intern Med. 1982 Jun;96(6 Pt 2):871-4
references.pmid: 7091959
references.citation: Plast Reconstr Surg. 2000 Jul;106(1):204-7; discussion 208-9
references.pmid: 10883636