Staphylococcal scalded-skin syndrome in an adult due to methicillin-resistant Staphylococcus aureus.
We report a case of a 71-year-old man with staphylococcal scalded-skin syndrome (SSSS). The patient, with a chronic history of diabetes mellitus, was admitted to our hospital with lumbago, and a diagnosis of renal-cell carcinoma with bone metastasis was made. In hospital he had sudden onset of high fever and erythema, followed by the formation of flaccid bullae and exfoliation, with a positive Nikolsky sign. Methicillin-resistant Staphylococcus aureus (MRSA), producing exfoliative toxin B, was isolated from blood and bile cultures, and Aeromonas hydrophila was isolated from bile culture. Skin biopsy specimen showed a cleavage of the epidermis at the level of the granular layer. The patient was diagnosed as having SSSS and cholecystitis, and was treated with intravenous antibiotics and percutaneous transhepatic gallbladder drainage, which led to recovery. SSSS in adults is usually associated with immunosuppression. A. hydrophila is recognized as an opportunistic pathogen. SSSS should be considered in the differential diagnosis of immunocompromised adult patients with sudden onset of high fever and erythema.
Ito
Yoichiro
Y
Department of Internal Medicine, Gifu Red Cross Hospital, 3-36 Iwakura-cho, Gifu 502-8511, Japan. gifu-med@gifu.email.ne.jp
Funabashi Yoh
Miyuki
M
Toda
Katsuhisa
K
Shimazaki
Makoto
M
Nakamura
Toshiyuki
T
Morita
Eri
E
D016980:Aeromonas hydrophila / Q000302:isolation & purification; D000368:Aged; D003937:Diagnosis, Differential; D005083:Exfoliatins / Q000633:toxicity; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D013206:Staphylococcal Scalded Skin Syndrome / Q000175:diagnosis / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*
D005083:Exfoliatins