When a desquamating rash leads to a challenging diagnosis

Sara Almeida*, Filipa Briosa, Joana Rios, Paulo Oom

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

A desquamating rash may pose a true clinical challenge. Therefore, the history and clinical course are crucial to making an accurate diagnosis. We present the clinical case of a 17-year-old boy submitted to a pilonidalis sinus excision, who presented to the emergency department with erythema and desquamation of lips, a scarlatiniform rash, an extensive desquamation of the hands and feet, and an infection of the surgical site. Given the suspicion of a staphylococcal scalded skin syndrome intravenous antibiotics were immediately started. During day six of admission, a sudden itching erythematous and desquamative rash appeared on the face and body, which worsened after the administration of cefuroxime. Therefore, that antibiotic was stopped and subsequently clinical improvement was observed. A skin biopsy revealed toxiderma. A positive oral provocation test for cefuroxime confirmed the cause of toxiderma. This case leads to discussion about the importance of the clinical course to make the correct diagnosis.

Original languageEnglish
Pages (from-to)216-219
Number of pages4
JournalPortuguese Journal of Pediatrics
Volume52
Issue number3
DOIs
Publication statusPublished - 16 Jul 2021
Externally publishedYes

Keywords

  • Adolescent
  • Cefuroxime/adverse reactions
  • Drug hypersensitivity
  • Exanthema/etiology
  • Staphylococcal Scalded Skin Syndrome/complications
  • Staphylococcal Scalded Skin Syndrome/diagnosis
  • Staphylococcal Scalded Skin Syndrome/drug therapy

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