Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan.
Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan.
BMC Cardiovasc Disord. 2022 Oct 29;22(1):452. doi: 10.1186/s12872-022-02903-3.
Toxic shock syndrome (TSS) caused by Staphylococcus aureus in the postpartum period is a rare but life-threatening disease. We present a case of acute heart failure as the initial presentation of TSS due to methicillin-susceptible Staphylococcus aureus (MSSA) and describe its clinical characteristics with a systematic literature review.
A 34-year-old woman, 8 days after a normal vaginal delivery presented to our hospital with dyspnea and fever. She had jugular venous distension, bilateral leg edema, and erythema. Laboratory examinations revealed elevated NT-pro-BNP level of 3,233 pg/mL. Transthoracic echocardiography showed elevated tricuspid regurgitation peak gradient, with decreased respiratory variability of the inferior vena cava diameter and bilateral pleural effusions. The patient was hospitalized with suspicion of congestive heart failure. MSSA positive for toxic shock syndrome exotoxin-1 was detected in the culture of the perineal incision wound, and we diagnosed TSS caused by MSSA. Intravenous diuretics were administered, along with eventual cefazolin plus clindamycin. After 2 weeks of antimicrobial therapy, the patient showed improvement and was discharged. No recurrence was observed at the 24-month follow-up.
This is a rare case report of acute heart failure being the initial manifestation of TSS due to MSSA in the postpartum period. Clinicians should consider TSS as a possibility in postpartum patients with acute heart failure. This systematic review provides insights into its clinical features, treatment regimens, and prognosis of TSS by S. aureus in the postpartum period. TSS requires an appropriate, prompt diagnosis, because delayed treatment can be fatal.
金黄色葡萄球菌引起的产后中毒性休克综合征（TSS）是一种罕见但危及生命的疾病。我们报告了一例因耐甲氧西林金黄色葡萄球菌（MSSA）引起的 TSS 以急性心力衰竭为首发表现的病例，并通过系统文献复习描述其临床特征。
一位 34 岁女性，在正常阴道分娩后 8 天因呼吸困难和发热就诊于我院。她有颈静脉扩张、双侧下肢水肿和红斑。实验室检查发现升高的 NT-pro-BNP 水平为 3233pg/ml。经胸超声心动图显示三尖瓣反流峰压差升高，下腔静脉直径呼吸变化率降低，双侧胸腔积液。患者因充血性心力衰竭收入院。在会阴切口伤口的培养物中检测到产毒性休克综合征外毒素-1 阳性的 MSSA，我们诊断为 MSSA 引起的 TSS。给予静脉利尿剂，并最终给予头孢唑啉联合克林霉素。经过 2 周的抗菌治疗，患者病情改善并出院。在 24 个月的随访中未观察到复发。
这是一例罕见的产后急性心力衰竭为首发表现的 MSSA 引起的 TSS 病例报告。临床医生应考虑在产后急性心力衰竭患者中 TSS 的可能性。本系统评价提供了金黄色葡萄球菌引起的产后 TSS 的临床特征、治疗方案和预后的见解。TSS 需要及时、恰当的诊断，因为延迟治疗可能致命。
