A 30-year-old man presented with a 4-h history of severe headache, vomiting, diarrhoea and epigastric pain. 1 week previously, he had undergone a left hip arthroscopy in another hospital. He had no other medical history and his only medication was na-proxen for post-operative pain. His blood pressure was 70mmHg systolic, pulse rate 130 bpm, respiratory rate 24 bpm and temperature was 38.3°C. Physical examination was notable for a diffuse ery-thematous, blanching rash involving his face and trunk, conjunctival suffusion and mild abdominal tenderness. Laboratory studies were normal apart from a leucocytosis (18.1 x 109/l) and a creatinine of 149imol/l. The provisional diagnosis was of toxic shock syndrome (TSS) secondary to peri-operative staphylococcal infection of the hip joint. He stabilized initially with fluid resuscitation and intravenous ceftriaxone, vancomycin and clindamycin.
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