# Postoperative Staphylococcal Toxic Shock Syndrome in a Patient Following Right Knee Fracture Repair: A Case Report

## TL;DR

A patient developed life-threatening Staphylococcal Toxic Shock Syndrome after knee surgery, highlighting the need for early diagnosis and surgical intervention.

## Contribution

This case report emphasizes the importance of recognizing TSS in postoperative patients with systemic symptoms and rash.

## Key findings

- A postoperative patient developed TSS with fever, hypotension, and rash.
- MRSA infection in the knee joint was identified as the source of TSS.
- Early recognition and surgical intervention are critical for reducing TSS mortality.

## Abstract

Toxic shock syndrome (TSS) is a rare but life-threatening multisystem disorder most commonly caused by Staphylococcus aureus. It is characterized by the acute onset of high fever, hypotension, a diffuse macular rash, and multiorgan involvement. We report the case of a male in his late 30s who sustained a patellar fracture with associated retinacular injury following trauma and subsequently underwent open reduction and internal fixation. Several days after discharge, he developed fever, chills, hypotension, and a pruritic, erythematous rash. He was readmitted and initially evaluated by the orthopedic service, which did not recommend additional imaging or surgical intervention, as they did not believe the knee to be the source of infection. The dermatology service was later consulted for rash evaluation and raised the possibility of TSS based on the patient’s constellation of systemic symptoms with diffuse erythematous rash. The differential diagnosis included drug eruption, such as Stevens-Johnson syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS), though biopsy revealed spongiotic dermatitis.

Given the patient’s worsening shock presentation despite appropriate antibiotic therapy, dermatology recommended urgent re-evaluation of the surgical site to identify and treat the potential infectious source. The orthopedic team performed repeat imaging and surgical exploration, which revealed a methicillin-resistant S. aureus (MRSA) infection in the knee joint. This case underscores the importance of having a high index of suspicion for TSS in patients with systemic symptoms and cutaneous eruptions following orthopedic procedures. Recognition of characteristic cutaneous findings in a toxic-appearing postoperative patient should prompt consideration of TSS, as early diagnosis and surgical source control are essential to reducing morbidity and mortality.