Patient Dies From Missed Diagnosis of Toxic Shock Syndrome

Case Overview

This case involves a fifty-six-year-old male, with a history of obstructive uropathy, who presented to the ED of nausea and profuse, watery diarrhea. On physical exam, he displayed left thigh pain that was significantly out of proportion to the exam. The laboratory examination was remarkable for a significant bandemia without the presence of fever or leukocytosis. The differential diagnosis in the ER was a severe UTI or possible gastroenteritis. The patient was sent home with Cipro and told to follow-up with his primary care physician. The patient returned to the ED two days later in respiratory distress and with a new rash over his face, neck, and trunk. He was admitted to the hospital and had no urine output over the next twenty-four hours. The leg pain was much worse and the patient was no longer eating or ambulating. The patient was sent to the OR for exploration of a new found abscess on an abdominal X-ray. After returning from the OR, he had rising oxygen requirements and remained intubated. Chest X-ray findings were consistent with ARDS. The patient was persistently hypotensive despite aggressive fluid replacement and support with pressors. He died due to multi-system organ failure. The OR records show that the abscess was most likely infectious myositis and the cause of death was noted as sepsis and toxic shock syndrome.