We present the case of a 4-year-old girl who consulted for a painful erythrotic rash in the cervical region of 12 hours' duration. The patient had general malaise, no fever, respiratory symptoms or other additional symptoms. She had been assessed 6 hours earlier as a possible prurigo, having started treatment with corticosteroids and systemic antihistamines. Physical examination revealed skin erythema on the neck, armpits, chest and buttocks, with areas of skin peeling in the axillary and cervical areas and some yellowish crusty lesions in the cervical region. He also showed erythema and palpebral and conjunctival inflammation, and the rest of the physical examination was normal. The heart rate, respiratory rate and blood pressure were normal. Blood tests showed leukocytosis (12,300 leukocytes/µL, normal formula) without elevation of acute phase reactants.

With a presumptive diagnosis of SPEE, he was admitted and started treatment with i.v. cloxacillin, topical mupirocin, i.v. antihistamine, i.v. fluid therapy and analgesia. The evolution was initially unfavourable, with generalisation of the lesions and extension of the erythroderma. On the third day, IV clindamycin was added empirically to the treatment, with a very favourable evolution of the lesions after 24 hours. Subsequently, the blood culture was negative and the skin and nasal smear culture was positive for S. aureus (penicillin-resistant, sensitive to cloxacillin, amoxicillin-clavulanic acid and clindamycin). After six days of admission with parenteral treatment, discharge was decided to continue antibiotic treatment on an outpatient basis.