A two-year and ten-month-old girl with a history of atopic dermatitis presented to the emergency department with a 12-hour history of skin lesions on the trunk and generalized pruritus.
Afebril, with no other symptoms.
Physical examination revealed nonconfluent erythematous lesions on the trunk, which were assessed as habonous and evanescent, as well as the presence of exudate.
The rapid pharyngeal swab test is negative.
Acute parainfectious urticaria and pharyngitis of probable viral etiology are diagnosed.
After 36 hours of evolution, the patient returned due to progression of the skin involvement, with pruritic erythematous scaly lesions in the periocular and perioral regions and in infected plaques on the trunk and large folds.
The pharyngeal exudate persists, the patient remains afflicted and complains of pain when taking it.
Atopical sprout with over-infection was diagnosed, starting treatment with oral paste dermatitis.
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At 72 hours of evolution comes again due to worsening of the lesions, associating febricula, decay and pain to skin palpitation.
Blood count with leukocytosis of 17500/mm3 without neutrophilia (neutrophils: 51%, lymphocytes: 34.8%) and C-reactive protein in 4.3 mg/l.
Finally, the patient was diagnosed with scalded skin syndrome. She was admitted for intravenous antibiotic treatment with clindamycin and cloxacillin.
The lesions were treated conservatively and perioral antibiotics were given.
Methicillin-susceptible Staphylococcus aureus was isolated in the conjunctival and pharyngeal exudates and in a skin lesion; the blood culture was sterile.
The patient evolved favorably and was discharged six days after admission.
