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+A girl aged two years and ten months with a history of atopic dermatitis attended the emergency department for skin lesions on the trunk and generalised pruritus of 12 hours' duration. She was afebrile, with no other symptoms. Physical examination revealed erythematous, non-confluent lesions on the trunk, assessed as haematous and evanescent, as well as the presence of tonsillar exudate. The rapid streptococcus test in the pharynx was negative. The patient was diagnosed with acute parainfectious urticaria and pharyngotonsillitis of probable viral aetiology.
+After 36 hours of evolution, the patient returned due to progressive skin involvement, with pruritic erythematodecamative lesions in the periocular and periorbital regions and in patchy plaques on the trunk and large folds, together with areas of superinfection and scratching lesions on the trunk. The pharyngeal exudate persists, she remains afebrile and complains of pain on picking her up. An outbreak of atopic dermatitis with superinfection was diagnosed and treatment was started with oral deflazacort.
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+Seventy-two hours later, the patient presented again with worsening of the lesions, associated with fever, malaise and pain on palpation of the skin. The haemogram showed leukocytosis of 17500/mm3 without neutrophilia (neutrophils: 51%, lymphocytes: 34.8%) and C-reactive protein of 4.3 mg/l. Finally, the patient was diagnosed with scalded skin syndrome and was admitted for intravenous antibiotic treatment with clindamycin and cloxacillin. Foments with 2% sodium borate and antibiotic ointment were applied to the palpebral and perioral lesions. Methicillin-sensitive Staphylococcus aureus was isolated in the conjunctival and pharyngeal exudate and in a skin lesion; the blood culture was sterile. The patient progressed favourably and was discharged six days after admission.
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