Toxic shock syndrome: sonographic appearance of the liver

Abstract

Toxic shock syndrome has been of great public interest because of reports that it is frequently associated with the use of vaginal tampons. This syndrome is characterized by therapid onset of high fever, vomiting, diarrhea, hypotension, erythematous maculan rash, and abnormalities of renal and liver function tests. Desquamation of the skin on the palms of the hands and the soles of the feet occurs 1-2 weeks after onset [1 , 2]. The syndrome is due to infection by Staphylococcus aureus which gains access to the vaginal mucosa. Such access appears to be facilitated by continuous use of vaginal tampons [2]. We report the finding of abnormal sonognaphic appearance of the liven in a case of toxic shock syndrome. Findings consist of increased brightness of the portal vein wall echoes with diminished echogenicity of the hepatic parenchyma. These findings were reported previously by Kurtz et al. [3] in association with acute hepatitis. They indicated that these appearances were not specific for hepatitis, since they were also seen in two patients with leukemia and in another with diabetic ketoacidosis. Our case furnishes another cause for this sonographic appearance.