Menstrual cup-associated staphylococcal toxic shock syndrome with septic cardiomyopathy: A case report and focused literature review

Background Menstrual toxic shock syndrome is a rare but potentially life-threatening condition historically associated with high-absorbency tampons. Menstrual cup-associated staphylococcal toxic shock syndrome has only rarely been described, and its clinical spectrum remains incompletely defined. Case report A 22-year-old woman presented with fever, rash, hypotension, and severe myalgias while menstruating with a menstrual cup in place. She developed vasopressor-dependent shock and septic cardiomyopathy with a left ventricular ejection fraction of 30%. Vaginal cultures grew methicillin-sensitive Staphylococcus aureus , blood cultures remained negative, and desquamation developed during hospitalization. She fulfilled the 2011 Centers for Disease Control and Prevention criteria for confirmed staphylococcal toxic shock syndrome and recovered fully after antimicrobial and supportive treatment. Review of the literature identified five previously reported menstrual cup-associated cases. Across the six well-described cases, half required vasopressors, and two had severe cardiac involvement, including cardiogenic shock in one and septic cardiomyopathy in the present case, suggesting that severe circulatory involvement may occur despite the rarity of this entity. Why should an emergency physician be aware of this? Menstrual cup-associated staphylococcal toxic shock syndrome is an uncommon but potentially life-threatening diagnosis. In young women presenting with shock, rash, diffuse myalgias, and current use of an intravaginal menstrual device, early recognition, device removal, and prompt initiation of toxin-suppressive therapy are critical.