Staphylococcal scalded skin syndrome (SSSS) describes a blistering skin infection caused by the exfoliative toxin in the bacterium Staphylococcus aureus. It more commonly affects the infant population and is characterized by large blistering bullae that rupture upon application of pressure.
We describe a case of recurrent SSSS in a healthy term neonate who initially presented with a perioral rash on day of life (DOL) 11 that quickly became vesicular with new lesions on the sternum and extremities. The patient’s rash began to resolve upon administration of culture-specific IV antibiotics. She was appropriately treated with a 14-day course and was discharged home.
The patient returned on DOL 35 with a perioral rash and generalized reddening of the skin. She was admitted and placed empirically on nafcillin, clindamycin, and vancomycin for concerning recurrence of SSSS. At this time, consults were placed to Dermatology, as well as Allergy & Immunology for possible Epidermolysis Bullosa and immune deficiency. Skin biopsy revealed development of recurrent SSSS. Patient finished another 14-day course of IV antibiotics and was discharged home with resolution of the rash.
This report discusses a case of recurrent SSSS in a term neonate who received two full courses of antibiotics and has since fully recovered.
Key words: Staphylococcal scalded skin syndrome, epidermolysis bullosa, disease recurrence
Conflict(s) of Interest
References with DOI
1. Dancer SJ, Simmons NA, Poston SM, Noble WC: Outbreak of staphylococcal scalded skin syndrome among neonates. J Infect 1988, 16:87-103. https://doi.org/10.1016/s0163-4453(88)96249-4
2.Ladhani and Evans: Staphylococcal scalded skin syndrome. Arch Dis Child 1998, 78: 85-88.
3. Lamond V, et al. Epidemiological data of SSSS in France from 1997 to 2007 and microbiological characteristics of Staphylococcal aureus associated strains. Clinical Microbiology and Infection 2012, E514-E521. https://doi.org/10.1111/1469-0691.12053
4. Duijster Carola, et al: Recurring staphylococcal scalded skin syndrome in a very low birth weight infant: a case report. J of Medical Case Reports 2009, 3: 7313. https://doi.org/10.4076/1752-1947-3-7313
5. Coleman JC, Dobson, NR: Diagnostic dilemma: extremely low birth weight baby with staphylococcal scalded skin syndrome or toxic epidermal necrolysis. J Perinatology 2006, 26:714-716. https://doi.org/10.1038/sj.jp.7211599
6. Has Cristina, et al: Recurrent staphylococcal scalded skin syndrome-like bullous mastocytosis: the utility of cytodiagnosis and the rapid regression with steroids. Pediatric Dermatology 2002, 19:220-223. https://doi.org/10.1046/j.1525-1470.2002.00077.x
7. Handler MZ, Scwartz RA: Staphylococcal scalded skin syndrome: diagnosis and management in children and adults. J Eur Acad Dermatol Venerol 2014, 11:1418-23. https://doi.org/10.1111/jdv.12541
8. Ming Li, et al: Staphylococcal scalded skin syndrome in neonates: An 8-year retrospective study in a single institution. Pediatric Dermatology 2014, 31: 43-47. https://doi.org/10.1111/pde.12114
9. Smith J and M Sandall: Staphylococcus scalded skin syndrome in the newborn: A case review. J Neonatal Nursing 2012, 18: 201-5.
Bhavsar, Indira; Hayes, Rebecca; and Vaughan, Amy
"Case Report: Recurrent Staphylococcal Scalded Skin Syndrome in Healthy Term Neonate Despite Full Course of Antibiotic Therapy,"
Marshall Journal of Medicine:
1, Article 6.
Available at: http://mds.marshall.edu/mjm/vol2/iss1/6