Overlapping Stevens-Johnson Syndrome and Staphylococcal Scalded Skin Syndrome in a Three-Year-Old Child: A Rare Pediatric Dermatologic Emergency

Abstract

Aims: To report a rare pediatric case presenting with overlapping Stevens-Johnson Syndrome and Staphylococcal Scalded Skin Syndrome complicated by impetigo in a three -year-old child, highlighting diagnostic and therapeutic challenges. Presentation of Case: A three-year-old female child presented to the emergency department with fever, perioral vesicles, crusting, and perioral pain. The symptoms began after an upper respiratory tract infection and treatment with amoxicillin. Over a period of four days, the child developed worsening vesiculobullous lesions with perioral crusting and mucosal involvement. Examination revealed erosive, erythematous lesions, positive Nikolsky’s sign, and inability to open the mouth due to lip involvement. There was no ocular or genital involvement. A diagnosis of overlapping Steven Jonson Syndrome (SJS) (Body Surface Area <10%) and Staphylococcal Scalded Skin Syndrome (SSSS) with secondary impetigo was made. The patient was managed with IV fluids, IV cefotaxime, paracetamol, ranitidine, topical paraffin, saline soaks, and zinc supplementation. Clinical improvement was noted within 5–7 days, and the child was discharged in stable condition. Discussion: Coexistence of SJS and SSSS is rare in children and presents diagnostic challenges due to overlapping features. Early differentiation and treatment are crucial, especially when diagnostic tools are limited. Conclusion: This report emphasizes the need for clinical vigilance in pediatric exfoliative dermatoses and the importance of early empirical therapy to ensure recovery.