Staphylococcal Scalded Skin Syndrome in a Healthy Adult: Easy to Misdiagnose
- Affiliations
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- 1Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea. pskwakcy@naver.com
- KMID: 2427394
- DOI: http://doi.org/10.12790/ahm.2018.23.4.271
Abstract
- A 60-year-old male presented with a three-month history of redness and swelling on his left little finger. His medical history was not informative. Wound culture revealed methicillin-resistant Staphylococcus aureus. After vancomycin administration, the skin lesions became worse and whole body bullae and desquamation occurred. This was initially suspected to be a drug eruption; thus, we switched antibiotics from vancomycin to teicoplanin. However, biopsy revealed Staphylococcal scalded skin syndrome (SSSS). After several days, generalized skin symptoms improved. The patient recovered and is in good physical health without recurrence six months later. We describe a localized form of SSSS, which is very rare in healthy adults. Consequently, there is a high risk of misdiagnosis. Thus, we report a rare case of SSSS in a healthy adult and the importance of early histological examination for accurate diagnosis.
MeSH Terms
Figure
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Fig. 1 Redness and mild swelling on the left little finger.
Fig. 2 There were no radiologic abnormalities.
Fig. 3 Hospital day 4. Despite of 4 days antibiotics treatment, skin symptoms did not improve.
Fig. 4 Hospital day 7. After 3 days of vancomycin use, multiple bullae on the whole body was appeared. (A) Left lateral chest. (B) Back and sacral area.
Fig. 5 Hospital day 12. Skin desquamation and discharge on left hand were even worse. (A) Dorsal side. (B) Palmar aspect.
Fig. 6 Skin biopsy result. Subcorneal splitting of the epidermis with superficial epidermal necrosis is seen. There are few inflammatory cells within the bulla cavity and there is only slight damage to the underlying epidermal cells. It suggests staphylococcal scalded skin syndrome (H&E, ×100).
Fig. 7 After discharge from the hospital with a 3-month follow-up clinical photo in the well-healed state. (A) Dorsal side. (B) Palmar aspect.
Reference
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