A case of toxic shock syndrome associated with methicillin-resistant Staphylococcus aureus parotitis in a 13-year-old male is presented. He was initially diagnosed with left-sided parotitis by his primary care physician, was started on sulfamethoxazole/trimethoprim, and became severely ill the following day. He was transported to the hospital after a syncopal episode at home and was found to have altered mental status, hypotension, and hypoxia. He was transferred to a larger care facility and died en route despite aggressive resuscitation. At autopsy, he was found to have a severe left-sided parotitis, severe pulmonary congestion, edema, and pneumonia, as well as bilateral lower limb hemorrhagic lesions. Blood cultures from the time of admission and at autopsy grew methicillin-resistant Staphylococcus aureus, which is rarely reported as the sole cause of parotitis. In addition, although S. aureus bacteremia is not necessarily a rare complication of a parotid gland infection, it is exceedingly rare in an immunocompetent adolescent.
From the *Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville; and
†Office of the Medical Examiner, Greenville County;
‡Pathology Associates of Greenville; and
§Greenville Health System University Medical Center, Greenville, SC.
Manuscript received February 26, 2018; accepted May 4, 2018.
The authors report no conflict of interest.
Reprints: Janet M. Basinger, MD, Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605. E-mail: email@example.com; firstname.lastname@example.org.