If your first thought upon reading the subject was "tampons," then congrats, you're normal. (If you don't know what that is, then that's normal too.) If your first thought was something other than tampons or nothing, then you're a freak of nature. (sorry. I hate to be mean, but really...what else is there besides "tampons"? Freak.)
We learned about it at some point second year of med school and they didn't teach us anything you can't find on the side of a tampon box. It's not particularly common, even among dedicated tampon wearers, but it does happen, in which case the treatment is removal of the tampon. Once you get that thing out, TSS usually clears up pretty quickly. Allegedly there are other ways of catching it, but as far as me and the rest of the world can tell, that's the only important way. Also, I remember Dr. McYummy telling me that I didn't need to know anything about it since I would never see anyone with it, now that the particular brand of tampon that was responsible for causing the outbreak was recalled.
Anyway, the other night when I was on call we got consulted in the ER for a 15 year old boy who had had metal pins stuck in his arm for a humerus fracture and was now presenting with an infection. The pin sites looked fine but the kid looked pretty sick. I asked the ER attending if we could consult pediatrics to admit the kid, he agreed, the kid got admitted that night. It wound up being the right decision because something happened that night and the kid crashed. Between when I saw him on Friday evening and 6AM Sunday, the kid wound up intubated, ventilated, sedated, and with a blood pressure so low they had to start him on multiple pressors.
He was diagnosed with toxic shock syndrome, source of infection unknown.
Dr. Sweaty: They now think he has toxic shock syndrome
Me: Has he been using tampons?
Me: They now think [your pediatric patient with the pins] has toxic shock syndrome
Dr. Orthoking Jr.: Where is he hiding a tampon? It comes from tampons, right? I think that's what we learned in med school.
Me: I think that's the only thing we learned about it in med school.
Dr. Orthoking Jr.: It's nice to know that med school hasn't changed.
Dr. Orthoking Jr.: That patient who we put the pins in now has toxic shock syndrome.
Scrub Nurse: Why is he using tampons?
Me: Hey mom, what's the first thing you think of when you hear "toxic shock syndrome"?
We took out the pins, but they looked fine and they have yet to grow anything in the microbio lab. Anyway, I'm no doctor or anything, but I'm starting to wonder if it's not completely impossible that the kid actually does have a tampon inside himself. Assuming that Chuck Palahniuk short story did not lie to me, 15 year old boys like to do...uh...disgusting things to...uh...self stimulate. So I don't think it's completely inconceivable that he could have, well, I'm not going to spell it out here. But 15 year old boys are disgusting human beings and I don't think it's out of the realm of the possible that he does, in fact, have a tampon lodged inside him and it's causing all these problems.
I really think someone should give the kid a good rectal exam, but I'm not sure how to suggest it. And i'm not exactly about to sneak into his room and do it myself. Also, I didn't really want to dwell on what the kid did or didn't have lodged in his anus. (hey, there's a reason I'm in ortho and part of it involves staying the hell away from that thing) And it's possible that the kid has some foreign body that's not disgusting that's causing this problem, but we already removed the pins. What else is there?
I guess I'll never find out.