When a desquamating rash leads to a challenging diagnosis

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.