There were multiple conditions on the differential, but ultimately a skin biopsy confirmed a diagnosis of Staphylococcal Scalded Skin Syndrome (SSSS). SSSS is a syndrome of acute exfoliation of the skin typically following an erythematous cellulitis. The severity varies from a few blisters localized to the site of infection to a severe exfoliation affecting almost the entire body. SSSS is caused by epidermolytic toxins produced by certain strains (5%) of Staphylococci and is usually seen in neonates and young children. The toxins act at the zona granulosa of the epidermis causing cleavage of desmoglein 1 complex, which is an important protein in desmosomes that anchor keratinocytes to each other. This results in the formation of fragile, tense …show more content…
Then there is generalized erythema rapidly followed by the development of flaccid blisters and desquamation, as seen in this patient. The mucous membranes are not involved, which is also consistent with our patient. The surrounding areas of her face were involved, but the mucous membranes were spared. This condition is also associated with a positive Nikolsky sign. A Nikolsky sign is the ability to extend the area of superficial sloughing by applying gentle lateral pressure on the surface of the skin at an apparently uninvolved site. This was found incidentally in our patient when the adhesive tape of an IV line was removed resulting in sloughing off of the skin below it. Furthermore, due to the sloughing off of skin with pressure, there tends to be increased desquamation in areas of mechanical stress like the flexural areas, buttocks, hands, and feet. If SSSS is suspected, cultures should be obtained from the blood, the urine, the nasopharynx, the perianal area, and any other abnormal skin or suspected focus of infection. The intact bullae are sterile and will come back without growth. In this patient, blood cultures had no growth to date and the pan-cultures from the mouth, nares, eyes, and anus were non-specific. Diagnosis for SSSS is usually clinical, although it may be confirmed with skin biopsy that shows a cleavage plane in the lower stratum …show more content…
SJS and TEN are severe mucocutaneous reactions, most commonly triggered by medications, characterized by extensive necrosis and detachment of the epidermis. The two conditions are distinguished based on severity, which is scaled by evaluating the percentage of body surface area involved in the blisters and erosions. SJS is the less severe and more common condition with 30% of the body surface with mucous membranes involved in the majority of cases. The mucous membranes were not involved in this patient making SJS and TEN less likely. However, the mortality rate for SJS is 10% and TEN is 30%, which is why it was important to rule out these conditions before sending the patient home. Although SJS and TEN are usually triggered by medications, one study showed that approximately 20-25% of pediatric cases could not be clearly attributed to a drug. While this patient’s history does not indicate any new medications, we cannot simply rule out the possibility of SJS or TEN for that
The patient was referred for a new itchy and tender bilateral groin lesions that the patient says will drain pus. He also has multiple other complaints. He gives a history of being allergic to DOXYCYCLINE. As previously stated, he has tender sites which can drain pus off and on in his groin for years. There is also history of facial acne and scalp acne since his late teens. He took Accutane during his 20s with improvement by history. He flared and repeated Accutane about one year after completing the first course by his history. He is bathing with unscented Dove and uses cocoa butter lotion. He also has a second problem of itching over his back, shoulders, and arms, and legs
Patient is a 9 year old adolescent male, presents with a 2 day history of itching encrusted sores especially around the mouth area. Parent is using OTC antibiotic ointment with no improvement, no recent history of fever. Parent states that pat recently visited a petting zoo
The patient points out a rash on the back of her neck that she states happened after
The patient does state she has a lesion on her left calf that gets red and scaly. Sometimes it is there and sometimes it looks like it is almost gone away. It does not bleed.
John is a forty-five year old male who presented in the emergency room experiencing abdominal pain in the right lower quadrant of the ventral cavity. The pain is felt in the umbilical region, right iliac region, and right lumbar region. He is also experiencing pale skin and fatigue. John has a previous history of gastritis(inflammation of the stomach), gastroesophageal reflux disease(stomach acids coming into esophagus), and bradycardia (abnormally slow heart rate). After the laboratory drew blood, the doctor began examining John. Upon his examination, he discovered that John's epidermis was abnormally dry and flaky; this is also known as ichthyosis, proximal to the tibia and fibula. Once the blood work came back, the doctor found the source
Patient is an African-American male, in his mid to late twenties, with a diagnosis of Hidradenitis Suppurativa, which has been ongoing for the last three years, according to the patient. His wounds are post-operative, with about 20-30ml of serous sanguineous fluid discharge on the dressing, and packed with 2.5 inches of iodoform.
The rash can appear in more than one place on the body at the same time.
skin condition that staph is able to cause is cellulitis. It is more common in people who have a weakened immune system such as people who are immunocompromised, infants, and the elderly. Cellulitis is characterized by a red, warm patch on the skin paired with a fever. “The bacteria that cause cellulitis can spread rapidly, entering lymph nodes and your bloodstream. Recurrent episodes of cellulitis may cause chronic swelling of the affected limb” (Mayo, 2015). Cellulitis is spread extremely easily, and is a big issue within long term care facilities. The infection can be cured by antibiotics. However, there are cases reported stating that cellulitis is becoming resistant to some antibiotics. The doctor can order a culture to send to pathology.
The 34-year old male patient with the presenting symptoms of discolored skin patches and nodules, deformity of the nose, loss of libido, hair loss, testicular atrophy, partial loss of pinprick and temperature sensation, and enlarged nerves, has a disease called lepromatous leprosy. Lepromatous leprosy is when there are a large number of bacteria found in the skin lesions.
BB’s skin presents as pink, warm and dry. No obvious signs or symptoms of abnormal bruising or lesions present however, the patient states that the skin has of late has
Fixed drug eruption (FDE) is a unique type of cutaneous adverse drug reaction. They were first described by Bourns1 in 1889 and later by Brocq2 as “eruption erythemato-pigmentee fixe”. It is characterised by the appearance of a single or multiple sharply demarcated violaceous erythematous plaques that may blister and is often associated with pruritus. The lesions generally leave behind some amount of residual hyperpigmentation. These lesions typically appear within 30 minutes to 24 hours of administration of the incriminated drug.1 The usual sites of involvement are hands, feet, genitalia and perianal region whereas it is seen less commonly around the mouth and trunk. There is a characteristic recurrence at the same sites on repeat administration
The release of two exotoxins from certain strains of S. aureus can lead to Staphylococcal scaled skin syndrome (SSSS), which is characterized by blistering skin. Invasion into the body can lead to more serious health problems including pneumonia (a frequent complication of influenza), mastitis, phlebitis (inflammation of the veins), meningitis, and urinary tract infections. If the bacterium is allowed to colonize even deeper tissues more serious conditions such as osteomyelitis and endocarditis may result. The most serious consequences of these deeper tissue infections occur when the bacterium invades the bloodstream leading to septic shock and possibly death.
Objective: leg skin is shiny and has several enlarged veins, otherwise, skin is pale and evenly pigmented, no lesions or excoriations, good turgor. Nails are light pink, adhere to nail bed with 160-degree angle. Hair is grey, shiny and full; amount and distribution
lacerations, burns - including friction burns and scalds, drowsiness, pressure sores, cowering and flinching, unexplained hair loss,
After reading Kelly’s story I researched different skin infections that may cause a rash on a person. Four different infections I found were Scabies, Impetigo, also known as Indian Fire, Cellulitis, and Folliculitis (7). Scabies is a contagious rash caused by the itch mite Sarcoptes scabiei (6). Scabies is a rash that produces red itchy bumps (6). Impetigo is caused by Staphylococcus and Streptococcus bacteria (5). Impetigo is extremely contagious and is spread by close contact (5). Cellulitis can be caused by Staphylococcus and Streptococcus (4). Cellulitis is not contagious but causes a red heated rash in the area of infection (4). Lastly, Folliculitis was listed as a rash causing infection. Folliculitis is a skin infection that causes a rash around the hair follicles that look like red pimples (3). Although it can be caused by certain bacteria, causing damage to the hair follicles can cause this infection (8). The normal bacteria that causes Folliculitis is Staphylococcus aureus (3).