A DEADLY THREAT OF STAPHYLOCCUS: A RARE CASE OF STAPHYLOCOCCAL SKIN SCALDED SYNDROME WITH TOXIC SHOCK SYNDROME

Staphylococcal scalded skin syndrome (SSSS), also known as Ritter disease or neonatal pemphigus, is a rare exfoliating skin disease caused due to exfoliative toxin of Staphylococcus aureus. It primarily affects infants and younger children. Staphylococcal toxic shock syndrome (STSS) is an acute life-threatening multisystem illness also caused by toxigenic strains of Staphylococcus aureus. An 8 years old girl child was admitted to ICU in altered sensorium. She had history of high-grade fever with chills, diarrhoea, oliguria and generalized exfoliative erythematous skin rashes.She had abscess over the left arm following a tetanus toxoid injection given 2 weeks prior for a minor injury.On physical examination, child was pale and icteric. She had clinical features of shock with markedly deranged laboratory parameters including TLC,renal & liver enzymes,coagulation profile and electrolytes. Immediate supportive management was provided and empirical antibiotics started.Pus was drained from left arm abscess which showed growth of Methicillin resistant Staphylococcus aureus(MRSA).Blood culture was negative. A working diagnosis of Staphylococcal scalded skin syndrome with toxic shock syndrome was made. Patient responded well to antibiotics vancomycin & clindamycin, and other symptomatic management.SSSS with STSS is an acute emergency with multisystem involvement.A clinical suspicion with prompt diagnosis on the basis of clinical spectrum and microbiology reports can be life saving for the patient.