A Case of Epistaxis with Toxic Shock Syndrome

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A 50-year-old man was referred to our hospital with epistaxis from the right nostril. His left nostril had been packed with several pieces of gauze for a long time. Acute liver and kidney failure made control of the epistaxis difficult. Toxic shock syndrome (TSS) is associated with complications such as multiple organ failure or shock due to exotoxins, such as toxic shock syndrome toxin-1 (TSST-1), produced by Staphylococcus aureus. Definitive diagnosis of TSS is difficult, because the diagnostic criteria of the Centers for Disease Control and Prevention (CDC) are stringent. Although our present patient did not fulfill the diagnostic criteria, TSS was strongly suspected. TSS after sinus surgery has been frequently reported. Few studies have been published about TSS caused by gauze packing for epistaxis. It is necessary to be borne in mind the possibility of TSS not only after surgery, but also after gauze packing for epistaxis.