Images in Paediatrics
Neonatal erythroderma: An unforgettable image
Eritrodermia neonatal: una imagen inolvidable
Inés Biléu Ventura
, María Luís Tomé, Catarina Maia, Anabela Gomes
Corresponding author
Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
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array:1 [ "es" => array:1 [ "titulo" => "Eritrodermia neonatal: una imagen inolvidable" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1248 "Ancho" => 1674 "Tamanyo" => 258727 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0140" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The infant was irritable and presented with yellow or honey-coloured crusts around the mouth and purulent discharge from the umbilicus and conjunctivas.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 17-day-old neonate was admitted with a diffuse erythematous rash and peeling skin. The infant had been well until day 13 post birth, when a preauricular blister appeared. The patient had been born at 35 weeks via caesarean section after an uncomplicated pregnancy, resided in a hygienic environment and had no family history of cutaneous disorders.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The newborn presented with fever, crusty yellow sores in the face, conjunctivitis, purulent umbilical discharge (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and a positive Nikolsky sign<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) on examination. The oral mucosa was spared. The C-reactive protein level was elevated (56<span class="elsevierStyleHsp" style=""></span>mg/L). These features led to suspicion of staphylococcal scalded skin syndrome (SSSS), prompting initiation of empirical treatment with intravenous flucloxacillin. Methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> (MRSA) was isolated from skin and conjunctiva/umbilicus cultures, while the blood cultures were negative. Both parents tested negative for MRSA.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Flucloxacillin was discontinued and intravenous vancomycin administered for 14 days, with addition of topical mupirocin as an adjuvant in an attempt to eradicate colonization.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> After 3 days of therapy, the patient was afebrile and the skin lesions showed signs of healing. The newborn was discharged with intact skin (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and no recurrences have been documented.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Staphylococcal scalded skin syndrome is a rare, life-threatening neonatal condition. Early recognition prevents complications, guiding effective treatment.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Neonatal MRSA outbreaks often result from transmission from asymptomatic carriers and require MRSA screening.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Previous presentation: Northern Interhospital Pediatric Cycle held at the Ordem dos Médicos (Porto, Portugal), February 17, 2023.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1248 "Ancho" => 1674 "Tamanyo" => 258727 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0140" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The infant was irritable and presented with yellow or honey-coloured crusts around the mouth and purulent discharge from the umbilicus and conjunctivas.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 427 "Ancho" => 1207 "Tamanyo" => 64324 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0145" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Superficial skin desquamation at monitor electrode sites and skin flexures resulting from slight rubbing pressure (positive Nikolsky sign).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 710 "Ancho" => 1007 "Tamanyo" => 114911 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0150" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cutaneous outcome.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Staphylococcal scalded skin syndrome: diagnosis and management in children and adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.Z. Handler" 1 => "R.A. Schwartz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.12541" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "1418" "paginaFinal" => "1423" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24841497" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impetigo/staphylococcal scalded skin disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Lorena" 1 => "Dollani" 2 => "S. Kalyani" 3 => "Marathe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/pir.2018-0206" "Revista" => array:6 [ "tituloSerie" => "Pediatr Rev" "fecha" => "2020" "volumen" => "41" "paginaInicial" => "210" "paginaFinal" => "212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32238552" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Staphylococcal scalded skin syndrome in neonates: case series and overview of outbreaks" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.M. Nusman" 1 => "C. Blokhuis" 2 => "D. Pajkrt" 3 => "D.H. Visser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/antibiotics12010038" "Revista" => array:5 [ "tituloSerie" => "Antibiotics (Basel)" "fecha" => "2022" "volumen" => "12" "paginaInicial" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36671239" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009900000006/v1_202312211250/S2341287923002569/v1_202312211250/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009900000006/v1_202312211250/S2341287923002569/v1_202312211250/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923002569?idApp=UINPBA00005H" ]
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