Nasal Septal Abscess Causing Near-Fatal Toxic Shock Syndrome With Multiorgan Dysfunction: A Case Report

TL;DR

A rare nasal infection caused by MRSA led to severe complications including toxic shock and organ failure, but the patient recovered with aggressive treatment.

Contribution

This case report highlights the rapid progression and severe complications of MRSA nasal septal abscess.

Findings

MRSA nasal septal abscess can rapidly progress to toxic shock syndrome and multiple organ dysfunction.

Aggressive multidisciplinary management, including drainage and IVIG, led to recovery despite severe complications.

Necrotizing pneumonia and tension pneumothorax occurred during ventilator weaning, requiring chest drain insertion.

Abstract

Nasal septal abscess (NSA) is a rare collection of pus between the nasal septum and the surrounding lining tissues. We report a case of methicillin-resistant Staphylococcus aureus (MRSA) NSA rapidly progressing to bacteremia, toxic shock syndrome (TSS), multiple organ dysfunction syndrome (MODS), and necrotizing pneumonia within days of presentation, with a favorable outcome. A young male diagnosed with NSA, periorbital cellulitis, and bilateral cavernous sinus thrombosis was admitted to the ICU. His condition deteriorated further, developing septic shock and requiring endotracheal intubation and two vasopressors (noradrenaline and vasopressin). He also developed acute kidney injury, necessitating continuous renal replacement therapy. The NSA was drained, and blood and pus cultures grew MRSA. Antibiotics were adjusted to meropenem, vancomycin, and clindamycin. On day 4, the patient developed severe acute respiratory distress syndrome, requiring prone positioning. After receiving a course of IVIG, his condition began to improve. His ventilation/perfusion (P/F) ratio improved, urine output normalized, and vasopressors were weaned by day 6. He subsequently developed necrotizing pneumonia that led to tension pneumothorax during ventilator weaning, which was managed with chest drain insertion. The patient underwent tracheostomy and was eventually weaned from mechanical ventilation, transferred to the medical ward, decannulated, and discharged home. MRSA NSA can progress to life-threatening TSS with MODS and necrotizing pneumonia, which may complicate ventilator weaning with tension pneumothorax. Early recognition and aggressive multidisciplinary management are critical for favorable outcomes.

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