Case Report : Recurrent Staphylococcal Scalded Skin Syndrome in Healthy Term Neonate Despite Full Course of Antibiotic Therapy

Background: Staphylococcal scalded skin syndrome (SSSS) describes a blistering skin infection caused by the exfoliative toxin in the bacterium Staphylococcus aureus. It more commonly affects the infant population and is characterized by large blistering bullae that rupture upon application of pressure. Case description: We describe a case of recurrent SSSS in a healthy term neonate who initially presented with a perioral rash on day of life (DOL) 11 that quickly became vesicular with new lesions on the sternum and extremities. The patient’s rash began to resolve upon administration of culture-specific IV antibiotics. She was appropriately treated with a 14-day course and was discharged home. The patient returned on DOL 35 with a perioral rash and generalized reddening of the skin. She was admitted and placed empirically on nafcillin, clindamycin, and vancomycin for concerning recurrence of SSSS. At this time, consults were placed to dermatology, as well as allergy & immunology for possible epidermolysis bullosa and immune deficiency. Skin biopsy revealed development of recurrent SSSS. Patient finished another 14-day course of IV antibiotics and was discharged home with resolution of the rash. Conclusion: This report discusses a case of recurrent SSSS in a term neonate who received two full courses of antibiotics and has since fully recovered.