A Case of Adult Staphylococcal Scalded Skin Syndrome Occurring in a Patient with Dermatomyositis

Abstract

We report an adult case of staphylococcal scalded skin syndrome (SSSS) in a 73-year-old female patient who had diabetes mellitus and dermatomyositis. Four days after leaving the hospital, bullous lesions appeared on the body with subsequent generalization. The patient had not been administered any new drugs in the past 6 months. We performed a serological examination, including that for the detection of serum anti-BP180 antibody, skin biopsy and bacterial culture from fresh vesicles. The lack of mucosal involvement, presence of Nikolsky reaction, detection of S. aureus from vesicles, and epidermal necrotic changes shown by histological examination indicated that the condition initially started from bullous impetigo and subsequently resulted in adult SSSS. Skin lesions, including bullous lesions and painful erosions, quickly responded to intravenous administration of penicillin. Only a few cases of adults with SSSS have been reported. All clinical data strongly suggested that the present case developed SSSS due to immunosuppression induced by the systemic administration of corticosteroid for the treatment of dermatomyositis. Therefore, a careful follow up of patients with an immunosuppressive condition is required to prevent a serious systemic infection such as SSSS.