[Toxic shock syndrome as a result of opportunistic infection].

Toxic Shock Syndrome (TSS) is a potentially fatal illness caused by a particular strain of Staphylococcus aureus. The clinical presentation is similar to that of septic shock because of systemic inflammatory response syndrome-(SIRS). In the case report ineffective therapy of puerperal staphylococcal infection and its complication (reactive arthritis) with bacteriostatic and anti-inflammatory drug was described. 24 years old woman with puerperal infection was empirically treated with doxycycline. Fever and general weakness disappeared, but four weeks later gonarthritis with stiffening developed (reactive arthritis) treated with steroids plus amoxicillin-clavulanate. Unfortunately after regression of gonarthritis and steroid withdrawal TSS and SIRS suddenly occurred. It was successfully treated with penicillin plus gentamycin. In the history of TTS the infection and inflammation are closely interwoven: clinical recovery from immunocompromise is associated with the onset of SIRS. Further, bacterial growth occurs when inflammatory process was quite inhibited (by puerperium or steroids). The natural history of the TSS confirm that regression of inflammatory symptoms in infectious diseases (especially in SIRS) is not tantamount to recovery. Moreover, immunocompetence is main requirement of successful treatment with bacteriostatic agents.