Fujiwara Y, Endo S
Department of Obstetrics and Gynecology, Kyoto First Red Cross Hospital.
Kansenshogaku Zasshi. 2001 Oct;75(10):898-903. doi: 10.11150/kansenshogakuzasshi1970.75.898.
Toxic Shock Syndrome (TSS) secondary to mastitis is seldom described. We present a case of TSS due to postpartum mastitis caused by Methicillin-resistant Staphylococcus aureus (MRSA). Five weeks after giving birth to a healthy boy, a 23-year-old secundipara was readmitted to the hospital with a fever, systemic erythema, nausea, vomiting, diarrhea, diffuse myalgia, generalized itching, orthostatic syncopes, photophobia, oligurea and pain in the left breast. Laboratory data on admission revealed deteriorated renal and coagulation function. Administration of Vancomycin, Imipenem, dopamin and nafamostat mesilate was started immediately after admission, that was effective. The patient recuperated steadily over the next week with apparent desquamation of the skin on her face, breast and extremities especially palms and soles. MRSA isolated from her milk was coagulase type II producing toxic shock syndrome toxin-1 (TSST-1) and enterotoxin C. Also immunoglobulin G against TSST-1 was not detected from her sera both on admission and on discharge, which suggested that the patient belongs to the high risk group of TSS recurrence.
很少有关于乳腺炎继发中毒性休克综合征（TSS）的描述。我们报告一例由耐甲氧西林金黄色葡萄球菌（MRSA）引起的产后乳腺炎导致的TSS病例。一名23岁经产妇在生下一个健康男婴五周后，因发热、全身性红斑、恶心、呕吐、腹泻、弥漫性肌痛、全身瘙痒、直立性晕厥、畏光、少尿和左乳疼痛再次入院。入院时的实验室检查显示肾功能和凝血功能恶化。入院后立即开始使用万古霉素、亚胺培南、多巴胺和甲磺酸萘莫司他进行治疗，治疗有效。在接下来的一周里，患者病情稳步恢复，面部、乳房和四肢尤其是手掌和脚底出现明显的皮肤脱屑。从她乳汁中分离出的MRSA为凝固酶II型，产生中毒性休克综合征毒素-1（TSST-1）和肠毒素C。入院时和出院时在她的血清中均未检测到抗TSST-1的免疫球蛋白G，这表明该患者属于TSS复发的高危人群。
