Although there are a lot of case reports of toxic shock syndrome (TSS) after surgery, most of these cases are of acute onset of TSS developed shortly after surgery. Here we present a case of TSS developed 25 days after rectal surgery for rectal cancer when the patient had been discharged.
A 62-year-old man presented with frequent bouts of defecation underwent rectal amputation with bilateral lateral lymph node dissection with the diagnosis of advanced rectal cancer. He was discharged without having complications at the postoperative day 8. He came to our emergency clinic because of a 3-day history of diarrhea at the postoperative day 28. He was diagnosed with dehydration and admitted to our hospital. After admission he had rapidly progressed hypotension, peripheral hypoperfusion and altered mentation, and then septic shock was diagnosed. He had fulminant course of septic shock, disseminated intravascular coagulation and multiple organ failure and died 70 hours after re-admission in spite of multimodality therapy. In consequence of autopsy and bacterial examination, he was diagnosed with TSS caused by MRSA infection of pelvic lymphocele. There are few case reports of late onset of TSS which occurred after a lapse of three weeks or more following the surgery. Because TSS could occur at any time after surgery, rapid and proper treatment should be done for postoperative sepsis with rash.