A Case of Toxic Shock Syndrome after Peritonsillar Abscess

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We describe a patient hospitalized for peritonsillar abscess who developed toxic shock syndrome. A 38-year-old male sought medical advice because of persistent high fever and sore throat with severe pain during swallowing. Physical examination found gross unilateral swelling of the palate and anterior pillar with medial displacement of the right tonsil. We diagnosed peritonsillar abscess and performed surgical drainage under antibiotic coverage. By the third hospital day the patient became afebrile and was gradually able to eat. However, he had a spiking temperature up to 40°C and his blood pressure was 80/50mmHg on the sixth day. He complained of nausea, vomiting and diarrhea. Laboratory data demonstrated a WBC count of 31, 800/μl, CRP level of 19.5mg/dl, BUN level of 27mg/dl, GOT and GPT level of 59 and 40IU/I. A stool culture revealed toxic shock syndrome toxin-1 (TSST-1) producing Methicillin Resistant Staphylococcus aureus (MRSA).