Diverging outcomes: The unpredictability of toxic shock syndrome. Case reports

Toxic shock syndrome is a rare but potentially fatal infectious process. It is mediated by superantigenic exotoxins, most commonly caused by Streptococcus pyogenes. These toxins activate T cells in an unconventional polyclonal manner, leading to cytokine storm, multiple organ failure, and death. Mortality depends on age, site of infection, comorbidities, and delayed diagnosis; hence the importance of timely recognition and treatment. We report two cases of women over 60 years of age, the first with the onset of multiple organ failure with fatal outcome less than 48 hours after admission to the ICU, and the second case with a less severe presentation who was discharged without complications. Both patients had the same diagnosis but different onset, symptoms, and outcomes.