レーザー鼻粘膜焼灼術後に発生したtoxic shock syndrome例

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  • A Case of Toxic Shock Syndrome After Nasal Cautery
  • レーザー ビ ネンマク ショウシャク ジュツゴ ニ ハッセイ シタ toxic shock syndromeレイ

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<p>Toxic shock syndrome (TSS) is a fatal bacterial intoxication caused by staphylococcal exotoxins. Herein, we report a rare case of TSS developing in a patient after nasal cautery.</p><p>A 34-year-old man with allergic rhinitis underwent CO2 laser-assisted nasal cautery at an ENT clinic. Nasal packing was not performed. Three days later, he presented to another clinic with pharyngeal pain, diarrhea and high fever (≥40℃). He was treated with levofloxacin under a diagnosis of acute pharyngitis, but the symptoms deteriorated. When he was first seen by us on the 7th postoperative day, his nasal cavities were filled with scabs, and marked hyperemia and fur formation were observed on the nasal and pharyngeal mucosae. He also showed erythematous rashes on his forearms and palms, tachycardia (113/min) and hypotension (78/61 mmHg). Laboratory data showed an elevated serum CRP level (37.18 mg/dl), thrombocytopenia (12.4×104/μl), leukocytosis with neutrophilia (29,900/μl, neutrophil 95.3%), and renal dysfunction (BUN 84 mg/dl, Cre 4.56 mg/dl, eGFR 13.41 ml/min). These findings met the criteria of probable TSS. The patient was hospitalized and started on fluid infusions and antibiotic therapy (vancomycin, clindamycin). Cleaning and washing of the nasal cavities were concomitantly performed 3 times a day. His general condition, physical findings and laboratory data promptly recovered. Methicillin-resistant Staphylococcus aureus was detected by nasal culture, although blood culture was negative. The patient was discharged on the 15th postoperative day. When he revisited us 3 days later, desquamation of the palms and soles was observed, confirming the diagnosis of TSS. His clinical course has thereafter been uneventful.</p><p>Physicians should be aware that TSS may be induced even by minimally invasive surgeries, such as nasal cautery.</p>

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