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1.
Rev. Soc. Bras. Clín. Méd ; 15(2): 109-111, 20170000. ilus
Article in Portuguese | LILACS | ID: biblio-875562

ABSTRACT

A síndrome da pele escaldada estafilocócica é uma dermatose esfoliativa rara no adulto, que acomete cerca de 0,09 a 0,56 por milhão de habitantes. É causada por exotoxinas produzidas por Staphylococcus aureus e manifesta-se com a formação de lesões bolhosas difusas pelo corpo. O diagnóstico é feito por meio de exame físico, hemocultura, cultura de sítio infectado e análise histopatológica. As medidas de suporte e a antibioticoterapia são a base do tratamento. Este relato descreve o raro acometimento de paciente idoso e evidencia a associação da doença com a imunossupressão. A presença de lesões em mucosa oral é um achado atípico e similar a um dos principais diagnósticos diferenciais da síndrome da pele escaldada estafilocócica: a necrólise epidérmica tóxica. É de suma importância diferenciá-las por meio de análise histopatológica das lesões de pele devido às formas inerentes de tratamento e à gravidade. O relato alerta para a importância do rápido reconhecimento do diagnóstico, a fim de introduzir tratamento adequado precoce, evitando os riscos da terapia inadequada e das complicações naturais da doença. Desta forma, é possível alcançar um desfecho positivo em uma doença de baixa prevalência e alta mortalidade no adulto.(AU)


The Staphylococcal Scalded Skin Syndrome is a rare exfoliative dermatitis in adults, affecting about 0.09 to 0.56 per million inhabitants. It is caused by exotoxins produced by Staphylococcus aureus and is manifested by the formation of diffuse bullous body lesions. The diagnosis is made through physical examination, blood culture, infected site culture, and histopathology. Supportive measures and antibiotics are the mainstay of the treatment. This report describes the rare involvement of an elderly patient, and highlights the association of the disease with immunosuppression. The presence of lesions in the oral mucosa is an atypical finding, being similar to one of the main differential diagnosis of the Staphylococcal Scalded Skin Syndrome: the Toxic Epidermal Necrolysis. It is very important to differentiate them through histopathology of the skin lesions due to the peculiar forms of treatment and the severity of the diseases. The report highlights the importance of rapid recognition of diagnosis in order to introduce early appropriate treatment, avoiding the risks of inappropriate therapy, and natural complications of the disease. This way, it is possible to achieve a positive outcome in a disease of low prevalence and high mortality in adults.(AU)


Subject(s)
Humans , Male , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Dermatitis, Exfoliative/diagnosis , Staphylococcal Scalded Skin Syndrome/diagnosis , Staphylococcal Scalded Skin Syndrome/drug therapy , Dermatitis, Exfoliative/drug therapy
4.
Pediatr. (Asunción) ; 38(1): 53-56, abr. 2011. graf
Article in Spanish | LILACS | ID: lil-598877

ABSTRACT

Lactante de 10 meses de edad, de sexo femenino, procedente del área periurbana de Encarnación, ingresa con lesiones cutáneas de 7 días de evolución tipo ampollosas al inicio, que luego se rompieron dejando un exudado seroso y con costras, simulando una quemadura, rápidamente extensivas a todo el cuerpo. Examen físico: Paciente grave, hipoactiva e irritable, con lesiones descamativas en todo el cuerpo, con pocas lesiones ampollosas, signo de Nikolsky (+), áreas de piel agrietada, otras denudadas, con costras melicéricas. Signos de deshidratación severa y edema de extremidades. Tª 38ºC, Peso 8650 grs., Talla: 69,5 cm, FR 40, FC 150. Se instala vía central, se realizan expansiones con solución fisiológica y se inicia cefotaxima más oxacilina. Estudios auxiliares: Hemograma; GB 22400 por mm3, N 59%, L 41%, Hg 10,7 gr/dl, Hcto. 33 %, Glucosa: 103 mg/dl, Urea: 65mg/dl, Calcio: 5,4 mg/dl, PCR positivo, VDRL no reactivo, HIV negativo. Plaquetas 360000 por mm3, TP 35% de actividad, Albúmina: 2,1g/dl. Orina simple normal. Electrolitos; Sodio146, Potasio: 5,59. Rx de tórax normal. Al 3º día de internación presenta Hg7 gr/dl, Hcto 22 %, requirió transfusión de GRC, albúmina, vitamina K, corrección de Calcio por hipocalcemia y convulsiones. Recibió leche Kass1000 por SNG y se le realizó lavados de piel con solución fisiológica. Paciente muy grave y edematizada los 3 primeros días y luego con mejoría progresiva, fue dada de alta a los 14 días con nivel de albúmina de 3,6 g/dl, sin edemas y con la piel cicatrizada con indicación de emolientes cutáneos y orientación nutricional. El síndrome de la Piel Escaldada es una entidad grave cuando se presenta en la forma generalizada; en este caso la consulta tardía agravó la presentación clínica, ingresando la paciente en estado séptico y con complicaciones severas. El manejo de estos pacientes requiere de una UCIP, nuestra niña fue atendida en una sala de terapia intermedia con los recursos básicos para su tratamiento exitoso.


Introduction: Staphylococcal Scalded Skin Syndrome, or Ritter’s disease, is a severe skin condition caused by the systemic impact of the exfoliative toxin produced by Staphylococcus aureus phage-group II, which causes intradermal separation in the granular layer. The diagnosis is clinical and supported by corroborative skin biopsy that excludes the differential diagnoses of epidermolysis bullosa or Stevens-Johnson syndrome. Case Presentation: Infant, 10 months old, female, from the peri-urban area of Encarnacion, was admitted with skin lesions of 7 days duration, initially of bullous type, which then broke, leaving a serous exudate and crusting, similar to the results of a burn, which quickly extended all over her body. Physical exam: Severely ill patient, underactive and irritable, with scaly lesions all over her body and a few bullous lesions, Nikolsky sign positive, areas of cracked skin, other areas bare with melicerous crusts, signs of severe dehydration, and swelling of limbs. Temp 38º C, weight 8650 grams, height: 69.5 cm, respiratory rate 40, heart rate 150. Installed central venous catheter; skin expansions done with saline, and initiated cefotaxime plus oxacillin. Ancillary studies: CBC: WBC 22400 mm3, neutrophils 59%, lymphocytes 41%, Hgb 10.7 g/dL, HCT 33%, glucose 103 mg/dL, urea 65 mg/dL, calcium 5.4 mg/dL, positive PCR, negative VDRL negative, HIV negative. Platelets 360 000 mm3, prothrombin time (PT) 35% of activity, albumin: 2.1 g/dL. Urinalysis: Electrolytes, Sodium 146, Potassium: 5.59, CXR normal. On the 3rd day of hospitalization HG 7 g/dL, HCT 22%, required transfusion of packed red blood cells PRBC, albumin, vitamin K, Calcium correction due to hypocalcemia and convulsions. Administered “Leche Kas 1000" (hydrolyzed sodium casein formula) administered by NGT and skin washed with saline. Patient was critically ill and edematous for the first 3 days then gradually improved...


Subject(s)
Pediatrics , Staphylococcal Scalded Skin Syndrome , Staphylococcal Scalded Skin Syndrome/complications , Staphylococcal Scalded Skin Syndrome/diagnosis , Staphylococcal Scalded Skin Syndrome/therapy
6.
Arch. argent. dermatol ; 56(3): 103-105, mayo-jun. 2006. ilus
Article in Spanish | LILACS | ID: lil-454424

ABSTRACT

La Acidemia Metilmalónica es un trastorno metabólico, caracterizado por un adecuado metabolismo de los aminoácidos esenciales. Las manifestaciones cutáneas en esta entidad son poco frecuentes en relación a otras aminoacidopatías. Presentamos la ocurrencia de lesiones cutáneas semejantes al Síndrome Estafilicocóccico de la Piel Escaldada en un neonato de 13 días de vida con diagnóstico de acidemia metilmalónica que fueron tratadas con antibióticos sin respuesta clínica, observándose la resolución de las mismas al ser compensado su cuadro metabólico


Subject(s)
Humans , Female , Infant, Newborn , Methylmalonic Acid/blood , Amino Acid Metabolism, Inborn Errors/diagnosis , Amino Acid Metabolism, Inborn Errors/diet therapy , Methylmalonyl-CoA Mutase , Staphylococcal Scalded Skin Syndrome/diagnosis
9.
Indian J Pediatr ; 2002 Oct; 69(10): 899-901
Article in English | IMSEAR | ID: sea-83372

ABSTRACT

Staphylococcal Scalded Skin Syndrome (SSSS) is a disease primarily of young children, characterized by exfoliative dermatitis caused by exfoliative toxin producing Staphylococcus aureus. We had three cases of SSSS with varied dermatological manifestations-diffuse/scarlitiniform erythema, generalized exfoliation, sand paper skin texture, flaccid bullae, erosions, seborrheic dermatitis like scaling and cracking in skin creases which can be confused with other skin conditions. Hence, a high index of suspicion, early diagnosis and prompt treatment is imperative.


Subject(s)
Female , Humans , Infant , Infant, Newborn , Staphylococcal Scalded Skin Syndrome/diagnosis
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