We report the case of a 4-year-old girl who consulted for a painful erythematous rash in the cervical region of 12 hours of evolution.
The patient had general malaise, no fever, respiratory symptoms or other added symptoms.
The patient had been evaluated for 6 hours as a possible precaution, having started treatment with systemic corticosteroids and antihistamines.
Physical examination revealed cutaneous erythema in the neck, armpits, chest and buttocks, with areas of cutaneous clearing in the axillary and cervical areas and a crusted lesion in the cervical region.
Erythema and conjunctival inflammation were also observed, and the rest of the physical examination was normal.
Heart rate, respiratory rate and blood pressure constants were normal.
Blood analysis showed leukocytosis (12,300 leukocytes/μL, normal formula) without elevation of acute phase reactants.
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With a presumptive diagnosis of SSEPS, he was admitted and started treatment with cloxacillin i.v., topical mupirocin, i.v. antihistamine, IV fluid therapy, and analgesia.
The evolution was initially unfavorable, with generalization of the lesions and extension of the erythrodermia.
On the third day, it is empirically associated with treatment with intravenous clindamycin. At 24 hours, a very favorable evolution of the lesions was observed.
Later the hemocultive was informed as negative and the culture of cutaneous and nasal swabs was positive for S. aureus (resistant to penicillin, sensitive to cloxacillin, amoxicillin-clavulanic acid and clinda).
After six days of admission with parenteral treatment it was decided to discharge to continue antibiotic treatment on an outpatient basis.
