Patient Story
An 18-month-old girl is admitted to the hospital with fever, irritability, and a tender skin rash on her face. She also has developed facial swelling bilaterally and perioral crusting (Figure 105-1). Over the next 24 hours, the rash spreads to her neck and trunk and she develops flaccid blisters on the areas of rash on her neck and trunk. When gentle friction is applied to involved areas of the skin, the skin easily sloughs superficially (Nikolsky sign). She is treated with intravenous anti-staphylococcal antibiotics and recovers completely. A culture taken from her nares grows Staphylococcal aureus.
Introduction
Synonyms
Epidemiology
Etiology and Pathophysiology
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Exfoliative toxins A and B of S aureus are responsible for the manifestations of the illness.1,2
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Mostly caused by S aureus belonging to phage group II, types 71 and 55.
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Toxins are hematogenously spread and produce the fever and characteristic rash.
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Toxin targets desmoglein 1, resulting in cleavage of the epidermis in a superficial location.3,4
Risk Factors

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