Regularly dosed upon routine biological work-ups, ferritin is revealed increased in a certain proportion of the population. At times, detection of hyperferritinemia leads to exhaustive and useless work-up, often including HFE genotyping. Although hemochromatosis is the most common genetic disease, this condition is not the primary cause of hyperferritinemia. In Western countries, metabolic syndrome and consumption of alcoholic beverages are the first etiologies to be considered. In general, a complete diagnostic approach, including complete medical history, clinical examination, and biology with a complete martial assessment, allows for identifying, without any specialized consultation required.

A 20-year-old female patient without comorbidities was admitted to the emergency department in a state of shock. Initially, a diagnosis of septic shock of urinary origin was established. The patient presented with abdominal pain associated with leukocyturia, along with a recent history of untreated cystitis. Admitted to the intensive care unit, the patient reported that she had kept a vaginal tampon for menstruation for over 24 hours during the day preceding her admission to the emergency department, following which the diagnosis of menstrual toxic shock syndrome (mTSS) was made. Antibiotic therapy with intravenous flucloxacillin and clindamycin was initiated.

This case presentation seeks to illustrate the different steps that led to this rare diagnosis, the relevance of a thorough history, as well as the treatment options.

What is already known about the topic?

This condition is a rare, yet possibly fatal disease, affecting women of childbearing age.

What does this article bring up for us?

This article provides a recent literature review, in addition to recalling diagnostic criteria, risk factors, management protocols, and treatment options, as well.

Key Words

Menstrual toxic shock syndrome, Staphylococcus aureus, toxic shock syndrome toxin 1, tampon, menstruation

Kidney transplant recipients (KTRs) are at increased risk of developing severe and lethal COVID-19 compared to the general population. Current therapies against severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infections are still limited. Nevertheless, growing evidence has revealed that KTRs exhibit a poor response to standard vaccine regimens, with humoral immune responses of roughly 50% at one month following two mRNA anti-SARS-CoV-2 vaccine doses. Moreover, most responders were shown to exhibit low antibody titers. Our experience at Cliniques universitaires Saint-Luc is perfectly in line with such data.

Considering these disappointing results, it is apparent that other strategies are required for KTRs and immunosuppressed patients, including a third vaccine dose along with monoclonal antibody therapy. This work’s aim is to provide a review on this topic and report on our experience at Cliniques universitaires Saint-Luc.