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VOLUME 16 , ISSUE 6 ( November-December, 2024 ) > List of Articles

CASE REPORT

A Case Report on Toxic Shock Syndrome Complicated with Symmetrical Peripheral Gangrene after Insertion of Intrauterine Contraceptive Device

Muna Bhutta, Nada AI AlSayed, Faiqa A Tullah, Sheela Nalini

Keywords : Case report, Multiple organ dysfunction, symmetrical peripheral gangrene, Toxic shock syndrome

Citation Information : Bhutta M, AlSayed NA, Tullah FA, Nalini S. A Case Report on Toxic Shock Syndrome Complicated with Symmetrical Peripheral Gangrene after Insertion of Intrauterine Contraceptive Device. J South Asian Feder Obs Gynae 2024; 16 (6):691-694.

DOI: 10.5005/jp-journals-10006-2522

License: CC BY-NC 4.0

Published Online: 19-11-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Toxic shock syndrome (TSS) is a lethal complication, which is rare. It is mediated by a toxin and can rapidly produce shock and multiorgan failure. It can lead to symmetrical peripheral gangrene (SPG), which is defined as ischemia or two or more limbs without obstruction of a large vessel or any vasculitis. Toxic shock syndrome can occur in some other clinical situations as well, like burns, nasal packing, and menstrual issues. The incidence of this syndrome is extremely low in gynecology, especially after intrauterine contraceptive device (IUCD) insertion. Case description: A 34-year-old female patient (Para 4 plus1), postpartum with lactational amenorrhea, was admitted as uterine perforation from the ER after IUCD insertion. The main complaints were abdominal pain, nausea, and vomiting. The patient's vital signs at admission were normal, but she developed shock within the next few hours. The patient was started on IV fluids, antibiotics, and analgesia and kept under observation. The patient became hemodynamically unstable. Official ultrasound revealed IUCD inside the uterus, marked fluid reaching up to Morrison's pouch, left ovarian cyst 2 × 2 cm, and pouch of Douglas contained free fluid. The patient underwent exploratory laparotomy. Mild to moderate hemoperitoneum was seen. Intrauterine contraceptive device was removed. She developed TSS, disseminated intravascular coagulation (DIC), multiple organ dysfunction syndrome, and SPG in the next few days. Multidisciplinary teams were involved in the management. The patient experienced discoloration of the hands, which worsened to dry gangrene. Conclusion: Symmetrical peripheral gangrene due to this syndrome is very rare in gynecology. The mortality rate due to TSS is high, and SPG may also follow it. Early diagnosis and aggressive treatment are important to save the patient. Clinical significance: Symmetrical peripheral gangrene caused by TSS following IUCD insertion is a rare and unsuspected occurrence. This fact should be kept in mind while managing gynecology patients.

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