Abstract
Toxic shock syndrome (TSS) is a severe postoperative infection characterized by rapidly progressing systemic symptoms, although local findings are typically unremarkable. Therefore, understanding its pathogenesis and ensuring early diagnosis are critical. To date, only 5 cases of TSS caused by methicillin-resistant Staphylococcus aureus have been reported in the context of breast reconstruction. We report a case of total mastectomy for breast cancer where a tissue expander was used. On postoperative day 12, the patient had hypotension, high fever, decreased consciousness, renal dysfunction, and gastrointestinal symptoms, indicating significant systemic deterioration. However, local findings at the surgical site were minimal, demonstrating a marked discrepancy between systemic manifestations and local signs. The patient was diagnosed with methicillin-resistant S. aureus-induced TSS, and the primary treatment strategy involved the complete removal of the capsule and the administration of intravenous antibiotics.