Archives of Hand and Microsurgery

The Korean Society for Surgery of the Hand (대한수부외과학회)
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Staphylococcal Scalded Skin Syndrome in a Healthy Adult: Easy to Misdiagnose

건강한 성인에서의 오진하기 쉬운 포도구균성 열상 피부증후군의 치험례

  • Kim, Hong Il (Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Kwak, Chan Yee (Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Park, Eon Ju (Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine)
  • 김홍일 (고신대학교 의과대학 복음병원 성형외과학교실) ;
  • 곽찬이 (고신대학교 의과대학 복음병원 성형외과학교실) ;
  • 박언주 (고신대학교 의과대학 복음병원 성형외과학교실)
  • Received : 2018.08.06
  • Accepted : 2018.09.03
  • Published : 2018.12.01
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Abstract

A 60-year-old male presented with a three-month history of redness and swelling on his left little finger. His medical history was not informative. Wound culture revealed methicillin-resistant Staphylococcus aureus. After vancomycin administration, the skin lesions became worse and whole body bullae and desquamation occurred. This was initially suspected to be a drug eruption; thus, we switched antibiotics from vancomycin to teicoplanin. However, biopsy revealed Staphylococcal scalded skin syndrome (SSSS). After several days, generalized skin symptoms improved. The patient recovered and is in good physical health without recurrence six months later. We describe a localized form of SSSS, which is very rare in healthy adults. Consequently, there is a high risk of misdiagnosis. Thus, we report a rare case of SSSS in a healthy adult and the importance of early histological examination for accurate diagnosis.

60세 남성이 3개월간 좌측 새끼손가락이 붓고 그곳의 발적 증상을 주소로 내원하였다. 과거력 상 특이 소견은 없었고, 균 배양 검사상 methicillin-resistant Staphylococcus aureus가 검출되었다. 반코마이신을 투여 후, 피부 병변이 악화되면서 전신 수포와 낙설이 발생하였다. 우리는 처음에 약물 발진 의진 하에 항생제를 반코마이신에서 테이코플라닌으로 변경하였다. 하지만 피부 조직검사 결과는 Staphylococcal scalded skin syndrome (SSSS)으로 나왔다. 수일 후, 환자는 전신 피부증상 호전되어 퇴원하였다. 우리는 건강한 성인에서 발생한 국소적 양상의 SSSS에 대해 보고하고자 한다. 이는 오진하기 쉬운 증례로서, 정확한 진단을 위하여서는 조기에 조직학적 검사가 중요할 것으로 생각된다.

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References

  1. Fitzpatrick TB, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS. Fitzpatrick's dermatology in general medicine. 8th ed. New York: McGraw Hill Medical; 2012. 2148-60.
  2. Miyashita K, Ogawa K, Iioka H, et al. Adult case of Saphylococcal scalded skin syndrome differentiated from toxic epidermal necrolysis with the aid of dermoscopy. J Dermatol. 2016;43:842-3. https://doi.org/10.1111/1346-8138.13281
  3. Aydin D, Alsbjorn B. Severe case of Saphylococcal scalded skin syndrome in a 5-year-old child - case report. Clin Case Rep. 2016;4:416-9. https://doi.org/10.1002/ccr3.535
  4. Mishra AK, Yadav P, Mishra A. A systemic review on Staphylococcal scalded skin syndrome (SSSS): a rare and critical disease of neonates. Open Microbiol J. 2016;10:150-9. https://doi.org/10.2174/1874285801610010150
  5. Cribier B, Piemont Y, Grosshans E. Staphylococcal scalded skin syndrome in adults. A clinical review illustrated with a new case. J Am Acad Dermatol. 1994;30:319-24. https://doi.org/10.1016/S0190-9622(94)70032-X
  6. Badon HR, King J, Brodell RT, Byrd A. Distinguishing features: Staphylococcal scalded skin syndrome vs toxic epidermal necrolysis. SKIN J Cutan Med. 2018;2:135-9. https://doi.org/10.25251/skin.2.2.7
  7. Patel GK, Finlay AY. Staphylococcal scalded skin syndrome: diagnosis and management. Am J Clin Dermatol. 2003;4:165-75. https://doi.org/10.2165/00128071-200304030-00003
  8. Ito Y, Funabashi Yoh M, Toda K, Shimazaki M, Nakamura T, Morita E. Staphylococcal scalded-skin syndrome in an adult due to methicillin-resistant Staphylococcal aureus. J Infect Chemother. 2002;8:256-61. https://doi.org/10.1007/s10156-002-0175-9
  9. Yamaguchi T, Yokota Y, Terajima J, et al. Clonal association of Staphylococcus aureus causing bullous impetigo and the emergence of new methicillin-resistant clonal groups in Kansai district in Japan. J Infect Dis 2002;185:1511-1516. https://doi.org/10.1086/340212