Domislović V, Sremac M, Kosuta I, Sesa V, Jovic A, Grsic K, Papic N, Mrzljak A. Managing toxic shock syndrome in immunosuppressed patient after liver transplantation from trauma to triumph: A case report. World J Clin Cases 2025; 13(24): 106827 [DOI: 10.12998/wjcc.v13.i24.106827]
Corresponding Author of This Article
Viktor Domislović, MD, PhD, Consultant, Researcher, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb 10000, Croatia. viktor.domislovic@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 26, 2025; 13(24): 106827 Published online Aug 26, 2025. doi: 10.12998/wjcc.v13.i24.106827
Managing toxic shock syndrome in immunosuppressed patient after liver transplantation from trauma to triumph: A case report
Viktor Domislović, Maja Sremac, Iva Kosuta, Vibor Sesa, Andrijana Jovic, Kresimir Grsic, Neven Papic, Anna Mrzljak
Viktor Domislović, Maja Sremac, Vibor Sesa, Anna Mrzljak, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Iva Kosuta, Department of Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Andrijana Jovic, Department of Diagnostic and Interventional Neuroradiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Kresimir Grsic, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Neven Papic, Anna Mrzljak, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Neven Papic, Department of Viral Hepatitis, University Hospital of Infectious Diseases Zagreb, Zagreb 10000, Croatia
Author contributions: Domislović V performed conceptualization, data interpretation and manuscript drafting; Sremac M, Kosuta I, Sesa V, Jovic A, Grsic K, and Papic N performed data collection and critical revision of the manuscript; Mrzljak A performed conceptualization, supervision, and critical revision of the manuscript. All authors have read and approved the final manuscript.
Informed consent statement: Patient has provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Viktor Domislović, MD, PhD, Consultant, Researcher, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb 10000, Croatia. viktor.domislovic@gmail.com
Received: March 9, 2025 Revised: April 27, 2025 Accepted: May 13, 2025 Published online: August 26, 2025 Processing time: 100 Days and 14 Hours
Abstract
BACKGROUND
Streptococcal toxic shock syndrome (STSS), caused by group A Streptococcus (Streptococcus pyogenes), is characterized by shock and multiorgan failure and is associated with a high mortality rate. Organ transplant recipients are especially vulnerable due to immunosuppressive therapy. Although critical for graft survival, immunosuppression increases susceptibility to infections, the leading cause of morbidity and mortality early after liver transplantation.
CASE SUMMARY
A 69-year-old female on dual immunosuppressive regimen with mycophenolate mofetil and tacrolimus due to liver transplantation in 2010 and chronic kidney disease presented to the emergency department after tripping at home and injuring her neck with a wooden splinter from a chair. She developed progressive neck swelling and erythema with a diffuse maculopapular rash. Contrast-enhanced computed tomography scan showed a multiloculated neck abscess (59 mm × 32 mm × 85 mm). Her leucocyte count was 22.4 × 109/L, C-reactive protein 327.4 mg/L, and creatinine 233 μmol/L. Microbiological analysis tested positive for group A Streptococcus, suggesting diagnosis of STSS. She developed hypotension, dyspnea and fever prompting an urgent surgical drainage. Mycophenolate mofetil was discontinued, tacrolimus was reduced and was treated with cephazolin and clindamycin. Her skin rash slowly resolved, C-reactive protein decreased to 53.0 mg/L and kidney function improved. A computed tomography scan confirmed resolution and showed no new abscess formation. After two years of follow-up, she is unremarkable.
CONCLUSION
STSS in organ transplant recipients demands rapid managing of infections while minimizing the risk of graft rejection.
Core Tip: Streptococcal toxic shock syndrome in organ transplant recipients is challenging and demands managing infections while minimizing the risk of graft rejection by modifying immunosuppressive therapy. This case highlights the importance of rapid interventions for infection control in patients after liver transplantation.
