TOXIC SHOCK SYNDROME AFTER FUNCTIONAL ENDONASAL SINUS SURGERY - AN ALL-OR-NONE PHENOMENON

Reported cases of toxic shock syndrome (TSS) following nasal surgery o r functional endonasal sinus surgery (FESS) are uncommon. Classic TSS is a serious multisystem disorder resulting from Staphylococcus aureus phage I toxic shock syndrome toxin 1 (TSST-1), and it is characterize d by fever, rash, hypotension, mucosal hyperemia, vomiting, diarrhea, and laboratory evidence of multisystem organ dysfunction. TSS cases fo llowing nasal surgery have been associated with nasal packing, mucosal barrier violation, prior S aureus phage I colonization, as well as lo w antitoxin antibody levels.(1) Of the 1700 FESS procedures performed at our institution, 3 cases were complicated by classic TSS, with 2 ad ditional patients having a postsurgical course compromised by a milder degree of TSS. Diagnostic criteria, clinical presentation, management , and etiology are discussed, and the possibility of a continuum from mild-to classic TSS is addressed.