Streptococcal toxic shock syndrome in the setting of recent
• An intrauterine device should be considered a potential source of infection in septic patients after uterine manipulation.

• In toxic shock syndrome, all foreign bodies should be removed and antibiotics started promptly.

• Criteria for toxic shock syndrome overlap with other causes of sepsis.

Toxic shock syndrome (TSS) is an acute, toxin-mediated disease process that is commonly caused by Staphylococcus aureus or Streptococcus pyogenes. A high level of clinical suspicion is imperative, with prompt antibiotic therapy with penicillinase-resistant penicillin (vancomycin in areas with increased methicillin-resistant Staphylococcus aureus) and clindamycin, given the high morbidity and mortality. Streptococcal-mediated TSS in a 37-year-old woman with a history of endometriosis, four days after a laparoscopic cystectomy; an intrauterine device (IUD) was left in situ at the time of uterine manipulation and not removed until hospital day 3 of the patient’s readmission. Although no specific guidelines exist for removing IUDs, it is a foreign body and therefore it is recommended that early removal be considered regardless of the level of suspicion that it is the source of sepsis.