Progression from Bullous Impetigo to Staphylococcal Scalded Skin Syndrome: A Case Study and Clinical Insights

Kannan N¹, Prabhu K², Jamunarani A³, Thatiparthi Stephen*⁴

This case determines the rare but critical progression from localized Bullous Impetigo to severe Staphylococcal Scalded Skin Syndrome, emphasizing the importance of vigilant diagnosis and timely treatment.

Abstract

Background: Staphylococcus aureus is known for causing various skin infections, including Bullous Impetigo and Staphylococcal Scalded Skin Syndrome (SSSS). Both conditions result from exfoliative toxins released by the bacterium but differ in their severity and systemic involvement. Bullous Impetigo presents as localized fluid-filled blisters, while SSSS involves widespread epidermal detachment and systemic symptoms. Methodology: A 10-month-old male infant with no significant past medical history presented with a rapidly worsening skin condition. Initially, the patient developed macules with shiny crusts around the perioral and periorbital areas, which evolved into larger bullae over two days, accompanied by fever. Diagnostic workup included swabs and tissue cultures, which identified amoxicillin-susceptible Staphylococcus aureus. A punch biopsy showed acantholysis and polymorphous infiltrates consistent with Bullous Impetigo transitioning to SSSS. Results: The patient was treated with intravenous amoxicillin-clavulanic acid and supportive care. There was significant improvement, with complete re-epithelialization of the skin observed within 12 days. Conclusion: This case highlights the potential for Bullous Impetigo to progress to SSSS, emphasizing the importance of early diagnosis and intervention. Clinicians should be vigilant for signs of progression from localized to systemic staphylococcal infections to ensure timely and effective treatment, preventing severe complications and optimizing patient outcomes.

Keywords: Staphylococcus aureus, Bullous Impetigo, Staphylococcal Scalded Skin Syndrome, exfoliative toxins, skin infections.

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