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A case of toxic shock syndrome after cesarean section
Abstracts / Journal of Reproductive Immunology 118 (2016) 109–141
was treated by antibiotics. He was diagnosed as hydrocephalus by brain MRI scan, at 34-day-old. He was performed surgical treatment 3 times, and he have no neurological disorder at 10-month-old. Listeriosis during pregnancy is a life-threatening infection for fetus and neonates. Antibiotics cannot prevent vertical transmission of L.monocytogenes completely, so it is important that we recommend pregnant women to prevent listeriosis. It is necessary to keep in mind of listeriosis and antibiotics treatment in case that pregnant women are suspected of having amnionitis or neonates are suspected of being sepsis. Conflicts of interest: The authors have no conflict of interest to declare. http://dx.doi.org/10.1016/j.jri.2016.10.035 27 A case of toxic shock syndrome after cesarean section Sayuri Masuko 1,∗ , Yukari Nishino 1 , Sanae Ichihashi 1 , Megumi Kaneko 1 , Takeo Miyamoto 1 , Mitsuhiro Nishijima 1 , Hideki Sakahira 2 1 Department of Obstetrics and Gynecology, Prefectural Awaji Medical Center, Japan 2 Department of Surgery, Prefectural Awaji Medical Center, Japan
Introduction: Toxic shock syndrome (TSS) is a disease caused by super antigen of Gram-Positive cocci, and leads to multiple organ failure and shock. Previously, most of the cases were caused by using sanitary product, but recently wound infection is the main cause of TSS. We report a case of TSS established after cesarean section surgery. Case: 34-year-old. We performed casarean section because of previous ceasarean delivery. The forth postoperative day, 39 degrees of fever, diarrhea, vomiting, sore throat appeared. Redness and many vesicles also appeared on patient’s body especially on forearms. Bacterial infection was suggested because of increasing of white blood and neutrophils, and antibiotic treatment was started. The fifth postoperative day, swelling of fingers, purpuric eruption, and decreasing of urinary amount were observed. Patient was admitted to intensive care unit (ICU) because septic shock was suggested by vital signs, clinical findings, and decreasing in consciousness. Patient was unresponsive to fluid administration, and it developed multiple organ failure and disseminated intravascular coagulation syndrome. Intubation and ventricular management was started due to depression of respiratory function. Heart function was severely decreased not to respond to pressor drugs, and percutaneous cardiopulmonary support (PCPS) and intraaortic balloon pumping (IABP) were also started. The eighteenth postoperative day, methicillin resistant Staphylococcus aureus (MRSA) was detected from the wound. Patient was recovered and extubated. There was no lack of higher brain function, but necrosis of fingers and legs caused by fulminant purpura existed. The twentyfirst postoperative day, patient was moved to general ward. After recovery of general condition, amputation of lower extremities and fingers was performed. Patient was discharged from hospital 4 month after the surgery. She still needs rehab with using prosthetic legs and braces. Conclusion: TSS takes rapidly progressive and critical course. In this case, patient’s life was saved because intensive care was started in early stage. TSS is one of the possibilities of differential diagnosis when puerperal fever takes rapidly progressive and critical course.
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Conflicts of interest: The authors have no conflict of interest to declare. http://dx.doi.org/10.1016/j.jri.2016.10.036 28 Probable toxic shock syndrome (probable TSS) which was caused by the MRSA infection at the puerperal period Moe Hamada ∗ , Ritsuko Yasuda, Yukiko Mizuno, Noriyoshi Oki, Mieko Inagaki, Homare Murakoshi, Zyuzo Okada, Shigeki Yoshida Chibune General Hospital, Japan A 33-year-old woman was transferred to our hospital due to the delivery stop. She underwent an emergency caesarean section. After surgery her SpO2 was decreased to 85–90% and the chest X ray depicted lung edema. She was controlled under intubation. She was diagnosed as having peripartum cardiomyopathy with echocardiography. She was treated successfully and discharged home 12 days postoperation. At the night of the discharged day, she showed fever-up and vomiting and visited the emergency department of our hospital the next day. Because laboratory data showed the elevation of WBC count and CRP, she was given intravenous administration of clindamycin for the treatment of postoperative infection. She had the allergy for the cephem antibiotic substances. Despite the therapy, fever-up to 40 degrees, erythema and low blood pressure were continued. The streptococcal toxic shock syndrome was suspected and treatment with tazobactam, piperacillin, and levofloxacin was started. Enhanced CT demonstrated the possibility of intrauterine infection and acute focal bacterial nephritis. MRSA was detected from vaginal and urine cultures, and we changed the antibiotics to the minocycline.Antipyretic was performed 17 days after surgery. 16 days after surgery, the worsening of the rash and itching appeared, and the patient was diagnosed as acute disseminated rash pustulosis. She got better with a few days of oral steroid therapy. Tazobactam and piperacillin were thought to be the cause of this disease. Finally, according to the diagnostic criteria of probable TSS, this patient was diagnosed as probable TSS caused by the MRSA infection. Paying attention to the symptom of erythema, we should consider staphylococcus aureus as the phlogogenic fungus which leads to the septic shock. In our case, we had trouble in choosing the antibiotics, considering both of the sensitivity for the estimated bacteria and the past history of allergy for the antibiotics. However, we should have started the vancomycin earlier, when we suspect the MRSA as the phlogogenic fungus. Conflicts of interest: The authors have no conflict of interest to declare. http://dx.doi.org/10.1016/j.jri.2016.10.037
was treated by antibiotics. He was diagnosed as hydrocephalus by brain MRI scan, at 34-day-old. He was performed surgical treatment 3 times, and he have no neurological disorder at 10-month-old. Listeriosis during pregnancy is a life-threatening infection for fetus and neonates. Antibiotics cannot prevent vertical transmission of L.monocytogenes completely, so it is important that we recommend pregnant women to prevent listeriosis. It is necessary to keep in mind of listeriosis and antibiotics treatment in case that pregnant women are suspected of having amnionitis or neonates are suspected of being sepsis. Conflicts of interest: The authors have no conflict of interest to declare. http://dx.doi.org/10.1016/j.jri.2016.10.035 27 A case of toxic shock syndrome after cesarean section Sayuri Masuko 1,∗ , Yukari Nishino 1 , Sanae Ichihashi 1 , Megumi Kaneko 1 , Takeo Miyamoto 1 , Mitsuhiro Nishijima 1 , Hideki Sakahira 2 1 Department of Obstetrics and Gynecology, Prefectural Awaji Medical Center, Japan 2 Department of Surgery, Prefectural Awaji Medical Center, Japan
Introduction: Toxic shock syndrome (TSS) is a disease caused by super antigen of Gram-Positive cocci, and leads to multiple organ failure and shock. Previously, most of the cases were caused by using sanitary product, but recently wound infection is the main cause of TSS. We report a case of TSS established after cesarean section surgery. Case: 34-year-old. We performed casarean section because of previous ceasarean delivery. The forth postoperative day, 39 degrees of fever, diarrhea, vomiting, sore throat appeared. Redness and many vesicles also appeared on patient’s body especially on forearms. Bacterial infection was suggested because of increasing of white blood and neutrophils, and antibiotic treatment was started. The fifth postoperative day, swelling of fingers, purpuric eruption, and decreasing of urinary amount were observed. Patient was admitted to intensive care unit (ICU) because septic shock was suggested by vital signs, clinical findings, and decreasing in consciousness. Patient was unresponsive to fluid administration, and it developed multiple organ failure and disseminated intravascular coagulation syndrome. Intubation and ventricular management was started due to depression of respiratory function. Heart function was severely decreased not to respond to pressor drugs, and percutaneous cardiopulmonary support (PCPS) and intraaortic balloon pumping (IABP) were also started. The eighteenth postoperative day, methicillin resistant Staphylococcus aureus (MRSA) was detected from the wound. Patient was recovered and extubated. There was no lack of higher brain function, but necrosis of fingers and legs caused by fulminant purpura existed. The twentyfirst postoperative day, patient was moved to general ward. After recovery of general condition, amputation of lower extremities and fingers was performed. Patient was discharged from hospital 4 month after the surgery. She still needs rehab with using prosthetic legs and braces. Conclusion: TSS takes rapidly progressive and critical course. In this case, patient’s life was saved because intensive care was started in early stage. TSS is one of the possibilities of differential diagnosis when puerperal fever takes rapidly progressive and critical course.
121
Conflicts of interest: The authors have no conflict of interest to declare. http://dx.doi.org/10.1016/j.jri.2016.10.036 28 Probable toxic shock syndrome (probable TSS) which was caused by the MRSA infection at the puerperal period Moe Hamada ∗ , Ritsuko Yasuda, Yukiko Mizuno, Noriyoshi Oki, Mieko Inagaki, Homare Murakoshi, Zyuzo Okada, Shigeki Yoshida Chibune General Hospital, Japan A 33-year-old woman was transferred to our hospital due to the delivery stop. She underwent an emergency caesarean section. After surgery her SpO2 was decreased to 85–90% and the chest X ray depicted lung edema. She was controlled under intubation. She was diagnosed as having peripartum cardiomyopathy with echocardiography. She was treated successfully and discharged home 12 days postoperation. At the night of the discharged day, she showed fever-up and vomiting and visited the emergency department of our hospital the next day. Because laboratory data showed the elevation of WBC count and CRP, she was given intravenous administration of clindamycin for the treatment of postoperative infection. She had the allergy for the cephem antibiotic substances. Despite the therapy, fever-up to 40 degrees, erythema and low blood pressure were continued. The streptococcal toxic shock syndrome was suspected and treatment with tazobactam, piperacillin, and levofloxacin was started. Enhanced CT demonstrated the possibility of intrauterine infection and acute focal bacterial nephritis. MRSA was detected from vaginal and urine cultures, and we changed the antibiotics to the minocycline.Antipyretic was performed 17 days after surgery. 16 days after surgery, the worsening of the rash and itching appeared, and the patient was diagnosed as acute disseminated rash pustulosis. She got better with a few days of oral steroid therapy. Tazobactam and piperacillin were thought to be the cause of this disease. Finally, according to the diagnostic criteria of probable TSS, this patient was diagnosed as probable TSS caused by the MRSA infection. Paying attention to the symptom of erythema, we should consider staphylococcus aureus as the phlogogenic fungus which leads to the septic shock. In our case, we had trouble in choosing the antibiotics, considering both of the sensitivity for the estimated bacteria and the past history of allergy for the antibiotics. However, we should have started the vancomycin earlier, when we suspect the MRSA as the phlogogenic fungus. Conflicts of interest: The authors have no conflict of interest to declare. http://dx.doi.org/10.1016/j.jri.2016.10.037