Toxic Shock Syndrome After Fractionated Ablative CO2 Laser
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Keywords
Toxic Shock Syndrome, fractional CO2 laser
Abstract
Patient History: A 62-year-old female with history of hyperlipidemia, alcohol use disorder and transient ischemic attack presented to the emergency department with disorientation and a diffuse exanthematous eruption. Five days prior, she underwent a cosmetic CO2 fractionated laser procedure at a medical spa by a non-board-certified physician. Two days post-treatment she developed fever, headache, nausea, vomiting, visual changes and profuse watery diarrhea. Her condition worsened, marked by persistent fever and continuous diarrhea. She was brought to the ED five days post-procedure after developing a rash and altered mental status. Vitals revealed tachycardia, hypotension, with subsequent vitals showing tachycardia and fever. Physical examination displayed a well-demarcated, mask-like honey-colored crusted facial rash with notable sparing around the eyes and lips, with a diffuse morbilliform rash and pronounced intertriginous erythema. Ultimately, she developed chronic petaloid facial scarring, decompensated mixed septic-cardiogenic shock and retinal injury before recovering from targeted antibiosis.
Biopsies & Laboratory data: Heavy growth methicillin-sensitive staph aureus on bacterial culture. Herpes Simplex and Zoster PCR negative. Severe thrombocytopenia. No histologic analysis was required for diagnosis.
Diagnosis: Staphylococcal toxic shock syndrome
Treatment: ICU resuscitation. Clindamycin, cefazolin, mupirocin, and prophylactic acyclovir in addition to cephalexin at discharge.
Discussion: This case highlights the severe complications that can arise post-cosmetic laser treatments, emphasizing the importance of a thorough patient history, post-operative care and communication, and proper training of personnel performing laser procedures.
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