Menstrual Cup-Associated Toxic Shock Syndrome

Eur J Case Rep Intern Med. 2020 Jul 22;7(10):001825. doi: 10.12890/2020_001825. eCollection 2020.

Abstract

Toxic shock syndrome (TSS) is a rare inflammatory response syndrome associated with an infection by toxigenic strains of Staphylococcus aureus or group A β-haemolytic Streptococcus. We report a rare case of menstrual TSS associated with usage of a menstrual cup. The diagnosis was established through case definition criteria and supported by vaginal cultural growth of Staphylococcus aureus with evidence of TSS toxin 1 (TSST-1). The patient received prophylactic intravaginal clindamycin in an individual approach to reduce the risk of recurrence. No relapse was reported in the 12 months following discharge.

Learning points: TSS should be considered in female patients presenting with fever, rash, hypotension and current menses. Prompt initiation of antibiotics and supportive care is critical.Menstrual cups may be a rare cause of TSS.Prophylactic antibiotic therapy may reduce the risk of relapse.

Keywords: Menstrual cup; menstrual toxic shock syndrome.