title: Bullous impetigo: a rare presentation in fulminant streptococcal toxic shock syndrome.
abstract: Since the mid-1980s, an increase in incidence of invasive disease caused by group A streptococci has been noted among adults and children. The characteristic clinical and laboratory features of the streptococcal toxic shock syndrome include deep-seated infection associated with shock, skin manifestation, and multiorgan failure. However, bullous impetigo is invariably considered to be a staphylococcal disease. Staphylococcus aureus produces an epidermolytic toxin, assumed to be the cause of bullous formation in the skin. Here, we present a case of bullous impetigo in an infant with streptococcal toxic shock syndrome. This is a rare presentation of bullous impetigo caused by group A streptococcus.
authors.affiliation: Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Jainn-Jim
authors.initials: JJ
authors.lastname: Lin
authors.forename: Chang-Teng
authors.initials: CT
authors.lastname: Wu
authors.forename: Shao-Hsuan
authors.initials: SH
authors.lastname: Hsia
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002439:Cefotaxime / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D003102:Colloids; D003131:Combined Modality Therapy; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005260:Female; D006801:Humans; D007169:Impetigo / Q000209:etiology*; D007223:Infant; D010949:Plasma; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D012872:Skin Diseases, Vesiculobullous / Q000209:etiology*; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D014640:Vancomycin / Q000627:therapeutic use; D014812:Vitamin K / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002316:Cardiotonic Agents; D003102:Colloids; D014812:Vitamin K; D002981:Clindamycin; D014640:Vancomycin; D002439:Cefotaxime