Fatal Streptococcal Toxic Shock Syndrome from an Intrauterine Device.
ABSTRACT BACKGROUND: The occurrence of toxic shock syndrome from an intrauterine device (IUD) is very rare. OBJECTIVES: To raise awareness of the risk of toxic shock syndrome caused by an IUD, to educate others about when to suspect this complication, and to provide treatment recommendations. CASE REPORT: A 49-year-old woman presented to the Emergency Department in septic shock after complaining of 5 days of nausea, vomiting, and diarrhea. Physical examination findings included a diffusely tender and rigid abdomen with free fluid on bedside sonogram. She was found, on computed tomography of her abdomen and pelvis, to have an IUD with moderate ascites. The IUD was removed, and both her IUD and her blood cultures grew out group A Streptococcus. Despite aggressive medical management, which included multiple vasopressors and broad-spectrum antibiotics, she died from group A streptococcal sepsis, with the IUD as her most likely source. Her clinical presentation and laboratory findings meet the Centers for Disease Control and Prevention diagnostic criteria for streptococcal toxic shock syndrome. Her diagnosis was confirmed by autopsy. CONCLUSION: IUDs should be considered as a possible source of infection in patients with an IUD who present with symptoms consistent with toxic shock syndrome. These patients need to be aggressively managed with early surgical intervention.
- JAMA The Journal of the American Medical Association 12/1977; 238(20):2178. · 29.98 Impact Factor
- Obstetrics and Gynecology 02/1973; 41(1):83-7. · 4.80 Impact Factor
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ABSTRACT: Peritonitis due to group A Streptococcus (GAS) and toxic shock syndrome occurred in a previously healthy 45-year-old woman with an intrauterine device. The intrauterine device was believed to be the portal of entry. In addition, her husband was found to be an asymptomatic carrier of GAS in his oropharynx. The goal was to increase physicians' awareness of oral sex as a risk factor for transmission of invasive GAS disease. This is a case report of the development of GAS peritonitis and toxic shock syndrome in a woman after acquisition of the organism through oral sex. The GAS strains isolated from the patient and her husband were identical in their M-type, T-type, and exotoxin gene pattern. Because the couple practices oral sex, it was postulated that this was the mode of transmission of the GAS.Sex Transm Dis 09/2002; 29(8):483-5. · 2.59 Impact Factor