A 55-year-old patient underwent tissue expander removal (Natrelle 133 MV; 250 cc) and implant insertion (BellaGel anatomical textured; tall height, medium projection; 250 cc) due to breast cancer found 1 year previously. The patient was discharged without any complications on POD 2, and her vital signs were stable. On POD 5, the patient was admitted to the emergency department with a high fever of 39.9°C, low blood pressure (SBP, 84 mmHg; DBP, 52 mmHg) and respiratory difficulty. The initial lab results showed an elevated WBC count of 11.04× 10
3/μL, a platelet count of 203×10
3/μL, and a high CRP level of 5.95 mg/dL. The surgical site showed slight swelling, along with breast tenderness. The patient complained of vomiting, diarrhea, and myalgia. An emergent operation for wound irrigation and drain insertion was performed immediately on the day the patient was admitted, and IV vancomycin (750 mg three times a day) and meropenem (1 g three times a day) were administered (
Fig. 6). Tissue culture from the breast wound grew MRSA. The WBC count, which was 11.04×10
3/μL on admission, increased to 19.59×10
3/μL on POD 1 and decreased afterwards. The platelet count, which was 203×10
3/μL on the day of admission, gradually decreased to 75×10
3/μL by POD 4, increased afterwards, and then stabilized. The CRP level also increased to 18.39 mg/dL by POD 2, decreased afterwards, and stabilized (
Fig. 7). However, mild fever persisted even after the operation, the wound site continued to show redness, and the patient complained of tenderness at the surgical site. Therefore, on POD 13, an implant change (BellaGel anatomical textured; tall height, medium projection, BATT-M; 220 cc) was performed and the patient was discharged 5 days later. The patient visited the outpatient clinic on a regular basis; however, the surgical site continued to show wound dehiscence and thin skin. Breast reconstruction with a latissimus dorsi flap and implant change (BellaGel anatomical textured; tall height, medium projection, BATT-M; 220 cc) was performed on POD 60, and no subsequent complications occurred (
Fig. 8). This patient also presented with fever, hypotension, and multisystem failure (gastrointestinal symptoms, muscular symptoms, low platelet count). Records of rash or desquamation were not found, but her general presentation fit the typical profile of TSS.