A Case of Postpartum Methicillin-resistant Staphylococcus Aureus Toxic Shock Syndrome: A Stitch in Time

Abstract

Toxic Shock Syndrome (TSS) is a sudden, systemic, toxin-induced disease that leads to the failure of multiple organs. It is a potentially fatal illness that might occur in the postoperative period. A 30-year-old woman in her second pregnancy, who had given birth via elective Lower Segment Caesarean Section (LSCS), presented to the Emergency Department on the tenth day after the surgery with septic features. She complained of a high-grade fever persisting for eight days, along with a rash that initially appeared on her upper limbs and gradually spread to her entire body. During the local examination, vulval excoriation with desquamation and peeling of the skin were observed. The imaging revealed a well-defined collection with heterogeneous enhancement in the infraumbilical region of the lower anterior abdominal wall. Multiple intralesional free air foci, primarily involving the bilateral rectus abdominis muscles, were also observed, along with mild fat stranding. These findings suggested an infective origin for the condition. The patient was stabilised and managed in the Surgical Intensive Care Unit (SICU). In order to combat the infection, broad-spectrum antibiotics with coverage against gram-negative bacteria were initiated. Subsequently, the patient developed a wound gap and underwent secondary wound closure. The present case report highlights the importance for healthcare practitioners to recognise the symptoms of postpartum TSS and take proactive measures to prevent its potential complications. Methicillin-resistant Staphylococcus Aureus (MRSA) is an iatrogenic and life-threatening infection; hence, proper treatment with a multidisciplinary approach will prevent maternal morbidity and mortality.

Keywords

• lower segment caesarean section
• postpartum infection
• surgical site infection