Case Presentation: This case involves a 53-year-old female with a past medical history of sigmoid colon cancer treated by resection and Capecitabine, type 2 diabetes with macro/microvascular complications, and obesity class II who presented to the emergency department with a rapidly worsening and blistering painful right leg ulceration. Associated symptoms included subjective fevers and chills. Patient stated that two days prior to admission, she noted a small, quarter sized lesion that prompted her to visit her primary care physician who prescribed cephalexin to treat cellulitis. The following day, the lesion erupted into several blisters circumferentially spread diffusely across the lower right extremity. The night prior to admission, the patient noted that the skin began to slough with light mechanical pressure. As a result, the patient was admitted and a clinical diagnosis of SSSS was made. Treatment including intravenous Linezolid and normal saline was initiated. The patient experienced rapid improvement of both systemic signs and clinical features. Her dermatologic symptoms were resolved by hospital day 3 and she was able to be discharged with outpatient follow up on hospital day 7.
Discussion: Staphylococcus aureus is an organism well known to cause severe infections that can affect a multitude of organ systems. Toxigenic strains of S. Aureus can cause staphylococcal scalded skin syndrome (SSSS) by producing exotoxins that disseminate to the skin to cleave desmosomes, resulting in separation of epidermal keratinocytes and superficial desquamation. SSSS primarily occurs in children and less frequently in adults, with an annual incidence of approximately 1 case per million adults. However, the mortality of SSSS has been shown to be significantly increased in adults with some reports showing a mortality rate greater than 60%.
Conclusions: Complications of SSSS are typically severe and may include secondary infection, electrolyte imbalances, sepsis, hypovolemia, and death. This case highlights that prompt treatment is crucial in preventing severe symptoms and mortality. It also illustrates the need for high vigilance by health care providers when assessing rashes, even in adults. SSSS should remain on the differential of diagnosticians when evaluating a rash and any assumed skin infection should be monitored for response to antibiotics. In addition, immunosuppressed patients are especially susceptible to the development of SSSS and must be given a proper physical examination with additional history-taking to investigate for undiscovered causes.