The Role of Gram Staining in Staphylococcal Scalded Skin Syndrome

Dan Morgenstern-Kaplan,Enrique Konstat-Korzenny,Rodrigo Fonseca-Portilla,Ariel Cohen-Welch

doi:10.7759/cureus.7624

Dan Morgenstern-Kaplan, Enrique Konstat-Korzenny + Show 2 more

Open Access

https://doi.org/10.7759/cureus.7624

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Journal: Cureus	Publication Date: Apr 10, 2020
License type: cc-by

Affiliation: Universidad Anáhuac

Abstract

Staphylococcal scalded skin syndrome (SSSS) is a severe blistering disease common in children. The diagnosis of SSSS is often difficult to distinguish from other blistering diseases in children. Here, we report a case of SSSS with a particular diagnostic step to elucidate the disease, which is the Gram stain. We propose the use of the Gram stain as a cost-effective diagnostic step in SSSS to shorten the time from presentation to treatment, especially in resource-limited areas.

Highlights

Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated epidermolytic disease that occurs mainly in infants and children
Certain strains of Staphylococcus aureus (S. aureus) release epidermolytic toxins A and B (ET-A and ET-B), which bind to desmoglein-1, causing blistering, acantholysis and desquamation of the skin
We propose the use of Gram staining as a fast and cost-effective diagnostic tool to differentiate the previously mentioned differential diagnoses, especially in resource-limited areas

Summary

Introduction

Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated epidermolytic disease that occurs mainly in infants and children. A previously healthy, immunocompetent four-year-old girl presented to the emergency department with fever, malaise and several blistering lesions that appeared after two days of pain and erythema in the neck and extremities. The lesions started as flaccid bullae that desquamated and afterwards crusted. They were localized in the neck, extremities and perioral and periorbital areas, with copious purulent secretions around the nares and eyes. All the lesions were painful and desquamated when pressure was applied (positive Nikolsky sign) (Figure 1). Patient with characteristic erythematous blistering skin lesions and acantholysis in the frontal chest area. Crusted lesion in the lateral cervical area with signs of previous blistering and erosion.

Discussion

Conclusions

Disclosures